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To quantify how specific patient-level characteristics influence the actual amount of mobilisation received during ICU care, thereby identifying key predictors to support individualised mobilisation strategies.
A prospective observational study was conducted in four tertiary hospitals among a convenience sample of 141 critically ill patients from July to November 2023. Data on mobilisation and patient characteristics were collected using standardised data collection tools, including a mobilisation log and a demographic information sheet. Data were analysed using non-parametric tests, Spearman correlation analysis, and multivariate regression to examine associations between early mobilisation and patient-related factors.
Males and surgical patients engaged in more activity (p < 0.001). Muscle strength (r = 0.568, p < 0.001) and haemoglobin levels (r = 0.207, p = 0.014) were positively associated with mobilisation, while higher disease severity (r = −0.321, p < 0.001) and greater pain (r = −0.284, p < 0.001) were linked to reduced activity. Muscle strength, disease severity, surgical status, and sex were independent predictors, explaining 32.5% of the variance.
Early mobilisation in the ICU is influenced by various patient-related factors. Protocols should be tailored to individual patient profiles to enhance outcomes.
This study provides guidance for ICU clinicians to develop targeted mobilisation strategies that consider patients' specific clinical profiles. Tailored approaches may help optimise early mobilisation practices and patient outcomes.
To explore the motivations, capacity preparations and career development plans of specialist nurses (SNs) to provide insights for promoting further specialisation in nursing and enhancing the quality of nursing services.
A descriptive phenomenological qualitative study was conducted.
The study was conducted from April to May 2024 at a tertiary hospital in China. A purposive sampling method was used to recruit 35 nurses from various departments of the hospital who had completed specialist nursing training and obtained the necessary qualifications. These SNs participated in face-to-face semi-structured interviews.
Three overarching themes and ten subthemes were extracted. (1) career choices for SNs, included the following subthemes: ‘Social support’, ‘Specialist nursing is charismatic’, ‘Demand for specialized nursing’ and ‘Possessing specialized nursing qualities’. (2) career preparations for SNs, comprised subthemes such as ‘Professional preparation’, ‘Quality requirements’ and ‘Qualification requirements’. (3) career development for SNs, encompassed subthemes like ‘Personal growth’, ‘Team building’ and ‘Disciplinary developments’.
This study explores the motivations and experiences of SNs' career transitions, highlighting social support, the appeal of specialty nursing, industry demand and professional competence. Governments should provide resources for career preparation, while nurses should enhance their knowledge and skills. Becoming a SN marks a new career phase, requiring skill improvement, teamwork and discipline involvement. The study offers insights for general nurses transitioning to specialty nursing and informs SNs' career planning.
These findings provide important guidance for the career development of nurses as specialists, highlighting the crucial role of government, hospitals and nursing advocates in fostering their professional growth.
The study was reported following the Consolidated Criteria for Reporting Qualitative Research Checklist.
No patient or public contribution.
(1) Impact on patients: this study underscores the significance of specialised nursing care and its potential to improve patient outcomes through enhanced expertise and individualised care. (2) Impact on clinical practice: by identifying the motivations and preparations for SNs' career transitions, the research emphasises the importance of specialised knowledge and continuous professional development to enhance clinical practice and quality of care. (3) Impact on education: the study advocates for more comprehensive educational programs and continuous professional development for SNs, ensuring they stay updated with the latest practices and research. (4) Impact on social and economic issues: Promoting specialty nursing can help address healthcare challenges, particularly with aging populations and chronic diseases, improving healthcare efficiency and reducing costs through targeted care.
(1) Establishing a standardised training and certification system is essential to ensure the professionalism, consistency and quality of specialist nursing practice. (2) Developing well-defined career pathways with research opportunities, leadership training and skill enhancement programs fosters SNs' professional growth, and strengthens their ability to adapt to evolving healthcare demands. (3) Enhancing professional autonomy and interdisciplinary collaboration will maximise the impact of SNs in improving patient care and driving healthcare innovation.
This study aims to investigate the prevalence of significant psychological distress and identify risk factors associated with it among early-stage lung cancer patients in the preoperative period.
Lung cancer is a major cause of cancer deaths worldwide, with low survival rates and significant psychological distress. While much research has focused on distress in advanced-stage patients, less is known about the prevalence and risk factors of psychological distress in early-stage lung cancer patients before surgery.
A cross-sectional study.
The study included 427 early-stage lung cancer patients preparing for surgery. Researchers used a study-specific questionnaire to gather general information and employed the Distress Management Screening Measurement, Patient Health Questionnaire-9 and Generalised Anxiety Disorder-7 to assess personal situations and psychological distress levels. Statistical analyses investigated distress across various patient characteristics and examined correlations with anxiety and depression. Binary logistic regression identified significant predictors of psychological distress.
The study found that 41.9% of early-stage lung cancer patients experienced significant psychological distress preoperatively, with an average score of 3.31 ± 2.18. Psychological distress was significantly positively correlated with depression (r = 0.474, p < 0.001) and anxiety (r = 0.591, p < 0.001). Significant risk factors for psychological distress included pulmonary nodules (OR = 2.884, 95% CI: 1.496–5.559), smoking history (OR = 2.092, 95% CI: 1.016–4.306) and chronic diseases (OR = 2.013, 95% CI: 1.073–3.776).
Early-stage lung cancer patients often experience a high incidence of clinically significant psychological distress during the preoperative period, strongly associated with depression and anxiety. Adverse factors contributing to psychological distress include multiple indeterminate pulmonary nodules, smoking history and concurrent chronic diseases. Routine screening for psychological distress in these patients is recommended, along with personalised interventions and self-management strategies to help alleviate their distress during the perioperative period.
To compare contextual factors influencing discharge practices in three intensive care units (ICUs).
A prospective observational study.
Data were collected using a discharge process report form (DPRF) between May and September 2023. Descriptive statistics were performed to analyse demographic and clinical data. One-way analysis of variance (ANOVA) was used to test the time interval differences among the three sites.
Overall, 69 patients' discharge processes were observed. Among them, 41 (59%) experienced discharge delay, and 1 in 5 patients experienced after-hours discharge. There were statistically significant differences in mean hours in various time intervals during the discharge processes among the three sites. Patients in Hospital C waited the longest time (mean = 31.9 h) for the ward bed to be ready after the bed was requested and for being eventually discharged after ICU nurses to get them ready for discharge (mean = 26.7 h) compared to Hospital A and Hospital B.
We found that discharge delay and after-hours discharge were common and there were significant differences in mean hours of various time intervals during the discharge processes occurred among the three sites. The influence of contextual factors in different hospitals/ICU needs to be considered to improve the ICU discharge process.
Researchers and clinicians should consider targeted context-specific interventions and strategies to optimise patient discharge process from ICUs.
The study findings will inform the development of tailored interventions to reduce the discharge delay and after-hours discharge and, in turn, improve the quality and safety of patient care and health service efficiency.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
Patients' discharge processes were observed, and consumer representatives were involved in the study design.
To evaluate and summarize the evidence for prevention and management of enteral feeding intolerance in critically ill patients and provide reference for clinical practice.
This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing.
Current literatures were systematically searched for the best evidence for prevention and management of enteral feeding intolerance in critically ill patients. Literature types included clinical guidelines, best practice information sheets, expert consensuses, systematic reviews, evidence summaries and cohort studies.
UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, the Cochrane Library, Embase, PubMed, Sinomed, Web of Science, Yi Maitong Guidelines Network, DynaMed, MEDLINE, CNKI, WanFang database, Chinese Medical Journal Full-text Database, European Society for Clinical Nutrition and Metabolism website, the American Society for Parenteral and Enteral Nutrition website were searched from January 2012 to April 2023.
We finally identified 18 articles that had high-quality results. We summarized the 24 pieces of best evidence from these articles, covering five aspects: screening and assessment of the risk of enteral nutritional tolerance; formulation of enteral nutrition preparations; enteral nutritional feeding implementation; feeding intolerance symptom prevention and management; and multidisciplinary management. Of these pieces of evidence, 19 were ‘strong’ and 5 were ‘weak’, 7 pieces of evidence were recommended in level one and 4 pieces of evidence were recommended in level two.
The following 24 pieces of evidence for prevention and management of enteral feeding intolerance in critically ill patients were finally recommended. However, as these evidences came from different countries, relevant factors such as the clinical environment should be evaluated before application. Future studies should focus on more specific symptoms of feeding intolerance and more targeted prevention design applications.
The clinical medical staffs are recommended to take evidence-based recommendations for the implementation of standardized enteral nutrition to improve patient outcomes and decrease gastrointestinal intolerance in critically ill patients.
The management of enteral nutrition feeding intolerance has always been a challenge and difficulty in critically ill patients. This study summarizes 24 pieces of the best evidence for prevention and management of enteral nutrition feeding intolerance in critically ill patients. Following and implementing these 24 pieces of evidence is beneficial to the prevention and management of feeding intolerance in clinical practice. The 24 pieces of evidence include five aspects, including screening and assessment of the risk of enteral nutritional tolerance, formulation of enteral nutrition preparations, enteral nutritional feeding implementation, feeding intolerance symptom prevention and management and multidisciplinary management. These five aspects constitute a good implementation process. Screening and assessment of enteral nutritional tolerance throughout intervention are important guarantees for developing a feasible nutrition program in critically ill patients. This study will be benefit to global medical workers in the nutritional management of critically ill patients.
This evidence summary followed the evidence summary reporting specifications of Fudan University Center for Evidence-based Nursing, which were based on the methodological process for the summary of the evidence produced by the Joanna Briggs Institute (JBI). The reporting specifications include problem establishment, literature retrieval, literature screening, literature evaluation, the summary and grading of evidence and the formation of practical suggestions. This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing, the register name is ‘Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients’, the registration number is ‘ES20231823’.
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