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Background: Delirium is one of the most common complications in critically ill children. Once delirium occurs, it will cause physical and psychological distress in children and increase the length of their ICU stay and hospitalization costs. Understanding the risk factors for delirium in critically ill children can help develop targeted nursing interventions to reduce the incidence of delirium. Aims: To investigate the incidence and the risk factors of delirium in the paediatric intensive care unit (PICU). Study design: We performed a prospective observational study in critically ill patients in the PICU between February and July 2020. Delirium was diagnosed by the Cornell Assessment of Paediatric Delirium (CAPD) and the Richmond Agitation Sedation Scale and analysed via univariate analysis and multivariate logistic regression to determine the independent risk factors of delirium in critically ill children. Results: The study enrolled 315 patients ranging in age from 1–202 (65.3–54.3) months, with 56.2% (n = 177) being male. The incidence of delirium was 29.2% (n = 92) according to CAPD criteria. Among them, 33 cases (35.9%) were of hyperactive delirium, 16 cases (17.4%) were of hypoactive delirium, and 43 cases (46.7%) were of mixed delirium. By using stepwise logistic regression, the independent risk factors of delirium included mechanical ventilation (odds ratio [OR], 11.470; 95% confidence interval [CI], 4.283–30.721), nervous system disease (OR, 5.596; 95%CI, 2.445 to 12.809), developmental delay (OR, 5.157; 95% CI, 1.990–13.363), benzodiazepine (OR, 3.359; 95% CI 1.278–8.832), number of catheters (OR, 1.918; 95% CI, 1.425 to 2.582), and age (OR, 0.985; 95% confidence interval CI, 0.976–0.993). Conclusions: Delirium is a common complication in the PICU. The independent risk factors include mechanical ventilation, nervous system disease, developmental delay, benzodiazepines, higher number of catheters, and younger age. This study may help develop intervention strategies to reduce the incidence of delirium in critically ill children by targeting modifiable risk factors. Relevance to Clinical Practice: Recommendations for practice include paying attention to high‐risk children in the ICU who are prone to delirium, removing influencing factors as soon as possible, and providing targeted nursing interventions. [ABSTRACT FROM AUTHOR]

Background: Despite extensive efforts and advances in developing and fostering evidence‐based delirium prevention interventions, the incidence of delirium remains high in hospitalized patients. Evidence suggests that sensory stimulation is a core component in interventions to prevent delirium among critically ill patients. However, its impact on the occurrence and outcomes of delirium is poorly understood. Aim: To evaluate the effects of a sensory stimulation intervention on preventing delirium in a surgical intensive care unit (ICU). Study Design: A prospective, assessor‐blind, parallel‐group randomized controlled trial. Adult patients were recruited from a surgical ICU of one tertiary hospital in Guangzhou, China. Participants in the intervention group received a daily 30‐min auditory and visual stimulation session for a week, taking into consideration the participants' predefined condition and intervention protocol. The primary outcomes were delirium incidence and delirium‐free days, and the secondary outcomes were delirium duration, severity and the first occurrence of delirium. Demographic and clinical data were collected at recruitment, and delirium was assessed three times a day for seven consecutive days using Confusion Assessment‐ICU. Results: One hundred and fifty‐two participants were randomly assigned to intervention or control groups. For primary outcomes, there were fewer patients with delirium in the intervention group than in the control group (10 vs. 19, risk ratio = 0.53), although statistical significance was not reached. The result showed that there were longer delirium‐free days among participants in the intervention group than in the control group (3.66 vs. 2.84, p =.019). For secondary outcomes, the intervention could significantly reduce delirium duration (1.70 ± 0.82 vs. 4.53 ± 2.74 days, p =.004) and delirium severity (3.70 ± 1.25 vs. 5.68 ± 1.57, p =.002). The Kaplan–Meier curve showed the intervention group had a significantly delayed first occurrence of delirium compared with the control group (p =.043). Conclusions: The study did not provide significant evidence to support that sensory stimulation could reduce the incidence of delirium, but significant difference on delirium‐free days. Relevance to Clinical Practice: This study provides evidence‐based practice for clinical healthcare providers to adopt the sensory stimulation protocol to prevent delirium, significantly reducing delirium duration and severity. [ABSTRACT FROM AUTHOR]

Aims: To investigate the beliefs and attitudes of intensive care unit (ICU) nurses and patients' family members towards an open visitation policy in the ICU in China and to explore the reasons that promote or hinder open visitation to improve visitation policy. Background: Open visitation policies are widely recommended in many countries. However, there are gaps between evidence and practice. Most ICUs in China still use a restrictive policy for family visits, which raises controversy. There are limited visiting times, and family visitors are not allowed to enter the ICU. Study Design: A multicentre survey was conducted in seven hospitals in China. The Beliefs and Attitudes towards Visitation in the Intensive Care Unit Questionnaire (BAVIQ) was administered to ICU nurses and patient families from 11 the ICUs of seven hospitals. A total of 275 questionnaires were completed and returned by ICU nurses and 139 by patients' family members. Results: Among nurses, the belief scale score was 2.87 ± 0.33 (range 2–4), and the attitude scale score was 5.53 ± 1.12 (range 2.33–7). The belief scale was divided into three subscales: nurses, patients, and patients' families. The subscale score for patients' families was the highest, and the nurses' subscale score was the lowest. Most (84.0%) of the nurses were satisfied with the current ICU visitation policy. The belief and attitude scores were 3.13 ± 0.39 (range 1.96–4) and 6.18 ± 1.20 (range 1.67–7), respectively, for family members. The scores of the three subscales, that is, patients, patients' families and nurses, were 3.13 ± 0.40, 3.26 ± 0.43, and 3.04 ± 0.49, respectively. Conclusion: Nurses' beliefs and attitudes towards implementing an open visitation policy in China are at a less positive level than those of patient family members. Relevance to Clinical Practice: The beliefs and attitudes of nurses towards open visitation policy in China need to be improved. The question of how to mobilize nurses' enthusiasm for an open visitation policy poses a challenge for ICU management. [ABSTRACT FROM AUTHOR]

Background: The field of early rehabilitation has developed slowly in mainland China and there are limited data on the implementation of early mobilisation (EM) practice in intensive care unit (ICUs) in China. Aims: To investigate the implementation of EM in ICUs in mainland China and to analyse its influencing factors. Study design: A cross‐sectional electronic survey was conducted in 444 ICUs across 11 provinces in China. Head nurses provided data on institutional characteristics and EM practice in ICUs. Logistic regression models were used to identify factors associated with the implementation of EM. Results: In all, 56.98% (253/444) of ICUs implemented EM with comprehensive or complete implementation in 86 ICUs. Of the 191 ICUs that did not use EM, 136 planned to implement EM in the near future. Of the 253 ICUs that used EM, 21.34% of ICUs implemented EM for all eligible patients, while 24.90% would evaluate and carry out EM within 48 h after ICU admission, 39.13% had collaborative EM teams, 34.39% reported the use of EM protocols, 14.63% reported multidisciplinary rounds and 17.39% had medical orders and charging standards for all EM activities. Only 18.18% of ICUs conducted frequent professional training for EM, and abnormal events occurred in 15.41% of ICUs during EM practice. Multivariate logistic regression analysis revealed that an economically strong province, the presence of a dedicated therapist team, more ICU beds and a higher staff‐to‐bed ratio favoured the implementation of EM. Furthermore, multidisciplinary rounds, well‐established medical orders and charging standards, and a high frequency of professional training can lead to the comprehensive promotion and development of EM practice in ICUs. Conclusions: Both the implementation rate and quality of EM practice for critically ill patients require improvement. EM practice in Chinese ICUs is still nascent and requires development in a variety of domains. Relevance to clinical practice: To facilitate the implementation of EM in ICUs, more human resources, especially the involvement of a professional therapist team, should be deployed. In addition, health providers should actively organize multidisciplinary rounds and professional training and formulate appropriate EM medical orders and charging standards. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) pandemic has spread globally and caused a major worldwide health crisis. Patients who are affected more seriously by COVID‐19 usually deteriorate rapidly and need further intensive care. Aim: We aimed to assess the performance of the National Early Warning Score 2 (NEWS2) as a risk stratification tool to discriminate newly admitted patients with COVID‐19 at risk of serious events. Design: We conducted a retrospective single‐centre case‐control study on 200 unselected patients consecutively admitted in March 2020 in a public general hospital in Wuhan, China. Methods: The following serious events were considered: mortality, unplanned intensive care unit (ICU) admission, and non‐invasive ventilation treatment. Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to quantify the association between outcomes and NEWS2. Results: There were 12 patients (6.0%) who had serious events, where 7 patients (3.5%) experienced unplanned ICU admissions. The area under the ROC curve (AUROC) and cut‐off of NEWS2 for the composite outcome were 0.83 and 3, respectively. For patients with NEWS2 ≥ 4, the odds of being at risk for serious events was 16.4 (AUROC = 0.74), while for patients with NEWS2 ≥ 7, the odds of being at risk for serious events was 18.2 (AUROC = 0.71). Conclusions: NEWS2 has an appropriate ability to triage newly admitted patients with COVID‐19 into three levels of risk: low risk (NEWS2 = 0‐3), medium risk (NEWS2 = 4‐6), and high risk (NEWS2 ≥ 7). Relevance to clinical practice: Using NEWS2 may help nurses in early identification of at‐risk COVID‐19 patients and clinical nursing decision‐making. Using NEWS2 to triage new patients with COVID‐19 may help nurses provide more appropriate level of care and medical resources allocation for patients safety. [ABSTRACT FROM AUTHOR]

Background: Turnover intention among nurses is high, especially in the emergency department. However, factors that are associated with Chinese emergency department nurses' turnover intention have been scarcely studied. Aims: The present study examined relationships between turnover intention and demographic characteristics, job‐related factors, depressive symptoms, and organizational commitment among emergency department nurses. Study Design: A cross‐sectional study of emergency department nurses was conducted in China between July and August 2018. The questionnaire included demographic characteristics (age, gender, level of education, and self‐rated health status), job‐related factors (qualification title, job seniority, night shifts, and workplace violence), depressive symptoms, organizational commitment, and turnover intention. A hierarchical linear regression model was used to identify factors that are associated with turnover intention among emergency department nurses. Results: A total of 17 582 emergency department nurses participated in the study. The response rate was 68.9%. The findings indicated that poor self‐rated health status (β = 0.25, p <.001), working more than 11 night shifts per month (β = 0.14, p <.01), experiencing workplace violence in the past year (β = 0.08, p <.05), and higher depressive symptom scores (β = 0.07, p <.001) positively correlated with turnover intention. More years of service (β = −0.38, p <.001) and higher organizational commitment scores (β = −0.45, p <.001) negatively correlated with turnover intention. Conclusions: Health status, job seniority, night shift frequency per month, workplace violence, depressive symptoms, and organizational commitment were significantly associated with emergency department nurses' turnover intention. Relevance to Clinical Practice: To reduce turnover intention in the emergency department nurses, hospital administrators and managers should implement measures to improve their physical and mental health, increase organizational commitment, develop staff acceptable shift schedules, and reduce incidences of workplace violence. [ABSTRACT FROM AUTHOR]

Background: Nurses in intensive care units (ICUs) play a crucial role in providing palliative care. Effective provision of palliative care in the ICU requires nurses' active engagement, yet little is known about the confidence for palliative care that ICU nurses hold in China. Aim: To explore confidence in performing palliative care among ICU nurses in China and factors related to nurses' level of confidence. Study design: A cross‐sectional design was implemented. Methods: This study utilized convenience sampling to recruit ICU nurses from nine hospitals in Wuhan, China. Data were collected via an online survey. Multiple regression was conducted to identify the predictors of the ICU nurses' confidence in performing palliative care. Results: A total of 231 ICU nurses participated in the study, resulting in a response rate of 78% (231/296). Participants reported a relatively low level of confidence for carrying out palliative care (mean score = 2.60 ± 0.53; range = 1‐4). Nurses who had more positive attitudes toward palliative care communication (P <.001), higher levels of formal training on palliative care (P <.001), more years of working as an ICU nurse (P <.05) and those working in integrated ICU (P <.001) showed a higher level of confidence in carrying out palliative care. Conclusion: Participants' lack of confidence in performing palliative care makes for increased challenges, particularly in uncertainty about family assessments, palliative care discussions and lack of palliative care training. Strengthening palliative care curricula in nursing education and professional training is imperative to enhance ICU nurses' confidence. Relevance to clinical practice: Strengthening palliative care education and training, particularly in relation to palliative care communication, is critical. Implementing and tailoring culturally relevant palliative care call for attention to practice and for policy changes in palliative care delivery in China. [ABSTRACT FROM AUTHOR]

Background: Nurses in intensive care units (ICUs) experience more stressful workplace conditions, making them more vulnerable to high levels of depression compared with those working in other healthcare settings. Objectives: This meta‐analysis aimed to estimate the pooled prevalence of depression in ICU nurses. Methods: A systematic search was conducted in Medline, EMBASE, CINHO, and Web of Science databases. Studies that reported depression among ICU nurses measured by a validated tool were synthesized using a random‐effects model. Differences in prevalence of depression by study‐level characteristics were estimated using sub‐group analysis. Heterogeneity was investigated using standard Chi‐squared tests and the I2 statistic. Results: Data were extracted from 19 cross‐sectional studies (2003‐2020) from 11 countries involving 7196 ICU nurses. The overall pooled prevalence of depression or depressive symptoms among ICU nurses was 24.99% (95% CI, 17.9%‐32.7%) with high between‐study heterogeneity (χ2 = 812, τ2 = 0.03, I2 = 98%, P <.01). Conclusion: Depression appears to be common among ICU nurses. Considering its negative impact on the quality of life of staff, patient care, and the overall critical care work environment, effective interventions should be designed and implemented to improve psychological health in this population. Relevance to clinical practice: Findings of this review indicate that regular screening for depressive symptoms might be helpful, and access to professional help and supportive care should be provided if necessary. [ABSTRACT FROM AUTHOR]

Background: Maintaining the patency of arterial catheters—routinely inserted in critically ill patients in intensive care units (ICUs)—is essential for obtaining physiological measurements and enabling blood sampling. Aim: This study aims to evaluate current ICU nurse knowledge and practice of maintaining the patency of arterial catheters and explore the factors that influence nurses' knowledge level. Design: This was a cross‐sectional survey conducted in China. Methods: This research was conducted in 20 tertiary hospitals in Beijing, China between March and June 2020. The data were collected by electronic questionnaire, which was designed in accordance with the literature and consisted of 28 questions. Descriptive and inferential statistics were used to analyse the data. Results: A total of 576 completed questionnaires were returned. The mean score of nurses' knowledges was 3.66 ± 1.35, which is a moderate level. There was a statistically significant difference between the mean scores of nurses with different professional titles and work experiences (mean 3.58 vs 4.04/7; mean 3.50 vs 3.58 vs 3.94/7). Considering ICU nurses' practice of maintaining the patency of arterial catheters, 376(65.3%)nurses replaced the pressure transducer as per the manual, and 347 (60.2%) nurses zeroed the pressure transducer once per shift. More than 90% ICU nurses aligned the transducer with the heart surface marker during zeroing procedures. Furthermore, 79.9% of nurses performed fast‐flush tests routinely, 459 (85.9%) nurses flushed the arterial catheter routinely, and 80% of nurses evaluated the patency of the arterial catheter every shift. Conclusions: This study found that the practices of ICU nurses varied, and their knowledge of how to maintain the patency of arterial catheters was moderate and could be improved. ICU nurses should be trained effectively to develop a unified standard of arterial catheter management. Relevance to clinical practice: Training programmes on arterial catheter management for ICU nurses are essential for improving knowledge and practice. [ABSTRACT FROM AUTHOR]

Background: Sleep abnormalities frequently occur in intensive care unit (ICU) patients, and the consequences of sleep abnormalities in patients who undergo off‐pump coronary artery bypass graft (OPCABG) surgery are particularly significant. Although many interventions have been reported to improve sleep, few sleep promotion protocols have been designed specifically for patients in cardiac ICUs. Aims and objectives: This study aimed to explore the effects of an evidence‐based sleep promotion protocol on patients who underwent OPCABG in a cardiac ICU. Design: A quasi‐experimental study was conducted in a comprehensive hospital in Shandong province of China. Methods: Overall, 67 participants were recruited (37 in the control group and 30 in the intervention group). An evidence‐based sleep promotion protocol was developed by a 10‐member interprofessional collaborative team and then applied. Sound levels, light intensity, and the number of nocturnal interventions were compared between groups. The Chinese version of the Richards−Campbell Sleep Questionnaire (RCSQ) was used to compare intergroup sleep status on two consecutive postoperative nights. Results: No significant differences were found for demographics or disease severity between the groups. In the intervention group, sound levels and light intensity were significantly lower at various times, and nocturnal interventions were significantly less frequent over the two consecutive nights. RCSQ scores were significantly higher in the intervention group for both nights. Conclusions: The sleep promotion protocol reduced sound levels, night‐time light intensity, the number of nocturnal interventions, and improved sleep among OPCABG patients in a cardiac ICU. Relevance to clinical practice: Evidence‐based practice can help to promote good quality of care, improve patient outcomes, and advance nursing in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Despite the frequency of its occurrence, few Chinese studies examined the status of intrahospital transport (IHT) of critically ill emergency room patients. Aims and objectives: To investigate the current status of IHT of critically ill patients and emergency nurses' perception of IHT across China; explore the perceived associations of written protocols with adverse events during IHT; and compare regional differences in IHT of critically ill patients across China. Design: A self‐report questionnaire was conducted among the attendees of a large emergency medicine conference in Beijing in May 2015. Methods: The data, collected through convenience sampling, were analysed using descriptive statistics. Categorical variables were compared using the chi‐squared test. Results: Of the 528 participants from 142 hospitals whose data were analysed, 19.3% considered all nurses competent enough to perform IHT of critically ill patients without special training, and 7.6% even considered nursing students capable of the task. The absence of written transport protocols was perceived to be significantly associated with the occurrence of adverse events such as oxygen supply depletion and incorrect destination. Hospitals in the western region were less likely to have established written IHT protocols and emergency checklists than those in the eastern region. Conclusions: Safe IHT of critically ill patients in the emergency department involves enormous challenges. The results of this survey can facilitate a preliminary understanding of the characteristics and current situation of IHT in emergency settings across China. Relevance to clinical practice: The establishment of standard transport protocols may help reduce the incidence of adverse events. [ABSTRACT FROM AUTHOR]

Background: Delirium affects up to 80% of patients in intensive care units (ICUs) and is associated with higher mortality, physical dependence, and health care costs. The 2018 pain, agitation, delirium, immobility, and sleep guideline recommended ABCDEF care bundle for delirium prevention and management. However, limited information is available regarding the adoption of the care bundle in ICUs in Mainland China. Aims and objectives: To assess the current implementation of the ABCDEF care bundle for delirium prevention as reported by ICU nurses in Mainland China. Design: A cross‐sectional study was conducted. Methods: A cross‐sectional online survey using a validated questionnaire about the practices of the ABCDEF care bundle was conducted among 334 registered nurses in 167 ICUs of 65 cities in Mainland China. Results: Almost 50% of the sampled ICU nurses were unaware of the ABCDEF care bundle, though 86.83% of the surveyed ICUs implemented pain assessments and 95.51% implemented sedation assessments. Nearly half (46.41%) of the surveyed ICUs performed routine spontaneous awaking trials, with 21.26% performing them daily. Spontaneous breathing trials were performed in 38.32% of the surveyed ICUs. Only 47% of the surveyed ICUs routinely monitored patients for delirium. About one‐third (38.35%) of the surveyed ICUs were supported by specialist teams that implemented the mobilization programmes. Most ICUs restricted the duration of family visits per day (<0.5 hour: 61.67%; 0.5‐2 hours: 23.65%; >2 hours: 3.29%) and only 28.14% of the surveyed ICUs employed dedicated staff to support the families. Conclusions: Although most of the surveyed ICUs implemented pain and sedation assessments, many of them did not implement structured delirium assessments. Early mobilization programmes and family participation should be encouraged. Relevance to clinical practice: Promoting the uses of a reliable delirium assessment tool such as Confusion Assessment Method for Intensive Care Unit patients, building an early mobilization team, and engaging family caregivers in the care plan may contribute to improved patients' clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Nurses are experiencing tremendous stress during the new coronavirus disease 2019 (COVID‐19) pandemic, especially intensive care nurses. The pandemic of the disease is a tragedy, which may leave a catastrophic psychological imprint on nurses. Understanding nurses' mental distress can help when implementing interventions to mitigate psychological injuries to nurses. Aims and objectives: To quantify the severity of nurses' post‐traumatic stress disorder (PTSD) symptoms and stress and explore the influencing factors of their psychological health when caring for patients with COVID‐19. Design: A cross‐sectional survey. Methods: The PTSD Checklist‐Civilian and the Perceived Stress Scale were administered from 11 to 18 March 2020, to 90 nurses selected from another city to go and help an intensive care unit (ICU) in Wuhan, China. These nurses were selected because of their high levels of clinical performance and resilience status. Results: Nurses' average PTSD score was 24.62 ± 6.68, and five (5.6%) of the nurses reported a clinically significant level of PTSD symptoms (>38 points). Nurses' perceived stress averaged 19.33 ± 7, and 20 nurses (22.22%) scored positively >25 points. Nurses' stress and PTSD symptoms were positively correlated (P <.01). Major stress sources included working in an isolated environment, concerns about personal protective equipment shortage and usage, physical and emotional exhaustion, intensive workload, fear of being infected, and insufficient work experiences with COVID‐19. Conclusions: This study showed that even relatively highly resilient nurses experienced some degree of mental distress, including PTSD symptoms and perceived stress. Our findings highlight the importance of helping nurses cultivate resilience and reduce stress. Relevance to clinical practice: Recommendations for practice include providing adequate training and orientation before assigning nurses to ICU to help, offering disaster‐emergency‐preparedness training to keep nurses prepared, providing caring and authentic nursing leadership, offering ongoing psychological support to frontline nurses. [ABSTRACT FROM AUTHOR]

Background: It has been recommended that critically ill patients start mobilization as early as possible. However, the clinical utilization rate of early mobilization remains low in the intensive care unit (ICU), and respiratory therapists and nurses are the primary practitioners of early mobilization in China. Aim: The aim of this study is to investigate the knowledge, attitudes, and perceived barriers of ICU nurses regarding the early mobilization of ICU patients. Design A descriptive and cross‐sectional design was used. Methods: A cross‐sectional design was used, with an e‐questionnaire for ICU nurses (n = 227) to assess knowledge and attitudes regarding early mobilization via the "Tencent WeChat" app on their smart phones. Results: As the primary implementers of the early mobilization of ICU patients in China, more than half of ICU nurses passed the knowledge test (scored ≥20/25 points) and had positive attitudes (scored 45/55 points) regarding early mobilization. Nurses had good knowledge (more than 96.5%) of the benefits and stopping indications of early mobilization; however, they had a poor understanding (less than 51.1%) of the population in which early mobilization is applicable and monitoring indicators during early mobilization, and 39.2% of nurses did not support routine implementation of early mobilization for patients in the ICU. The major barriers that they perceived were very heavy workload (76.8%), insufficient equipment and devices (50.2%), lack of written protocols or guidelines (50.2%), inadequate training (47.1%), potential work risks (42.3%), and limited staffing (41.4%). Conclusions: Although over half of ICU nurses exhibited relatively comprehensive knowledge of and positive attitudes to early mobilization, some misunderstandings, negativity, and barriers remain. Relevance to clinical practice: Training programmes should be conducted continuously, especially focused on common misunderstandings and negative attitudes. Organizational support is required to overcome barriers to the implementation of early mobilization. [ABSTRACT FROM AUTHOR]

Background: The specialist critical care nurse plays a vital role in the delivery of evidence‐based practice, and specific competency guidance has been established to facilitate critical care nursing practice and education development in many developed countries. However, no research has been conducted to develop a competency framework for specialist critical care nurses in China. Aims and objectives: To construct a competency framework specific to specialist critical care nurses in China. Design and methods: A two‐phased procedure was implemented. In phase 1, a literature review and four focus groups were used to develop the initial competency framework, which consisted of 101 statements. During phase 2, three rounds of a modified Delphi process were conducted and involved a national panel of 30 experts, including physicians, specialist critical care nurses, managers, and educators, who responded to the survey using a 5‐point Likert‐type scale to indicate their level of agreement with the competency framework. A 75% threshold for each competency was used to achieve panel consensus. Results: Experts in the field of critical care responded to rounds 1 (n = 29), 2 (n = 28), and 3 (n = 28). Seventy‐eight competencies were agreed upon after round 1, increasing to 88 after round 2 and 92 after round 3. The final competency framework was classified into six domains: evidence‐based practice, complex decisions, professionalism, communication and co‐operation, education and development, and leadership. Conclusion: The output of this study is an expert consensus competency framework that provides a sound foundation for the assessment and training of specialist critical care nurses. Relevance to clinical practice: The proposed competency framework should be used to assess nursing performance, promote continuing professional development, and further improve the delivery of quality health care and optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Sleep abnormalities occur frequently in critically ill patients. Nurses are strategically placed, specifically in intensive care units, to promote sleep in such patients. Currently, an effective sleep assessment tool in Chinese is not available for intensive care settings. Aim: This study aimed to assess the reliability and validity of the Chinese version of the Richards‐Campbell Sleep Questionnaire (RCSQ‐C). It also aimed to evaluate patient‐nurse reliability and agreement of the RCSQ‐C in the intensive care unit (ICU). Methods: We translated the original RCSQ into Chinese and then back‐translated it into English to ensure its accuracy of translation. Internal consistency, discrimination validity and construct validity of the RCSQ‐C were examined in 150 critically ill patients. The convergent validity of the RCSQ‐C was evaluated in 44 of 150 critically ill patients, and data from the RCSQ‐C were compared with those of the Chinese version of St Mary's Hospital Sleep Questionnaire (SMHSQ). Comparisons were also made between RCSQ‐C scores obtained from patients and their nurses. Results: Cronbach's α of the RCSQ‐C was 0.923; thus, it showed high reliability. The corrected item‐total correlation coefficient was in the range of 0·680∼0·805, which showed that the items were homogeneous for evaluating sleep. The content validity was 0·84. One factor was extracted with a cumulative contribution rate of 76·597%. Confirmatory factor analysis showed that the original single‐factor structure proposed by Richards adequately fit the data. The RCSQ‐C could discriminate poor and good sleepers, which supported discriminant validity. There was a close correlation between the scores obtained from the RCSQ patient's version and those from the SMHSQ. The intraclass correlation coefficients of the patient and nurse ranged from 0·315 to 0·609. Conclusions: The psychometric properties of the RCSQ‐C suggest its utility in critically ill patients. Patient‐nurse reliability on the RCSQ‐C was "fair" to "substantial", with nurses tending to overestimate patients' perceived sleep quality. Relevance to Clinical Practice: If the validity of this questionnaire is supported in other ICU samples, RCSQ‐C could be used as a routine evaluation instrument to distinguish good and poor sleepers and then direct nurses to form corresponding treatment plans to promote sleep. [ABSTRACT FROM AUTHOR]

Nurses play a key role in administering sedation to mechanically ventilated children, which impacts children's psychological, physiological and cognitive changes in the paediatric intensive care unit. This study aimed to survey the sedation practices of paediatric intensive care unit nurses on mechanically ventilated children in China and explored the influencing factors. A cross‐sectional survey was conducted based on electronic questionnaires comprised of the Nurse Sedation Practices Scale (Chinese version) in 14 different types of paediatric intensive care units of 11 academic hospitals in China from 15 February to 15 April 2017. A convenience sample of 495 nurses [73·4% response rate, (674)] completed the survey. Seven units applied Ramsay Sedation Scale as a sedative assessment tool. The majority of the nurses used observed behaviours and physiological changes of the ventilated children as indicators to assess the sedation level, and they had a positive attitude and intention, which may influence practice positively, whereas high clinical workload and the lack of communication between the nurses and families might hinder practice. The practice of sedation varied greatly in different regions, and the respondents of the northwest region scored lower. Paediatric nurses in China rarely used a validated paediatric instrument to assess sedation, and most nurses relied on physiological and behavioural cues. The quality of sedation training, nursing workload and regional economic disparity affected the sedation practice. The restricted visiting policy and lack of clearly defined nursing responsibilities around sedation may hinder effective sedation assessment and management. This study found that there was no paediatric‐validated tool popularized in paediatric intensive care units in China and explored influencing factors. We suggest that a validated tool, high‐quality training and hospital's policy, such as visiting regulation, should be promoted to improve the sedation practice. [ABSTRACT FROM AUTHOR]

Background: Core competencies of intensive care unit (ICU) nurses were defined as the essential capability to influence patient safety and interdisciplinary collaboration; however, there has been no research conducted that relates to core competencies of ICU nurses at Chinese tertiary‐A hospitals in Shanghai. Aims and objectives: To investigate the current state of core competencies and the factors that influence this key capability in ICU nurses in Chinese tertiary‐A hospitals. Design This was a multicentre, cross‐sectional study. Methods: A convenient sampling method was used to investigate 451 ICU nurses at five tertiary‐A hospitals in Shanghai. Data were collected using self‐administered questionnaires. Results: The core competencies of ICU nurses were above average, and the scores of seven dimensions, ranked from first to last, were medical ethics, clinical practice, nurse–nurse co‐operation, assessment and decision‐making, personal and professional development, teaching and research and nurse–physician co‐operation. Multivariate linear regression analysis showed that the factors exerting an influence on the core competencies of ICU nurses were title, role incumbent and ICU department. Conclusion: This study showed an above‐average level of core competencies among ICU nurses in tertiary‐A hospitals in Shanghai; however, competencies related to nurse–physician co‐operation and the translation of research into practice were underdeveloped. Relevance to clinical practice: Nursing managers should implement targeted interventions to improve nurse–physician co‐operation and translate research into practice competencies, such as high‐fidelity simulation, inter‐professional education, scientific research training and innovative skills tutorials. Moreover, this study demonstrated the influencing factors that can be used to improve core competences of ICU nurses. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that feeding a high‐energy formula (HF) to infants after cardiac surgery increases energy intake, with fewer side effects on cardiopulmonary function. However, impacts on weight gain and gastrointestinal function remain unclear. Aims and objectives: To determine the impact of HF compared with standard formula on weight gain and gastrointestinal tolerance in postoperative infants with congenital heart disease. Design This was a randomized controlled trial. Methods: The setting of the study was at a 20‐bed cardiac intensive care unit at a tertiary children's hospital in China. Study population included infants <1 year of age who underwent cardiac surgery and were allocated to the intervention group (n = 32) or control group (n = 32). The intervention group received HF (100 kcal/100 mL), and the control group received standard formula (67 kcal/100 mL) for 7 days during the stabilized postoperative period at the cardiac intensive care unit. Primary outcomes were weight gain and gastrointestinal intolerance. Secondary outcomes were energy intake and standard intensive care characteristics. Results: Infants who received HF (n = 30) showed less weight loss than those who received standard formula (n = 29); −16 g [95% confidence interval (CI): −74 to 42] versus −181 g (95% CI: −264 to −99), P = 0·001. The evaluation of gastrointestinal intolerance showed that the intervention group had several side effects, such as abdominal distension (n = 1), gastric retention (n = 2) and diarrhoea (n = 1), while the control group had no problems. Enteral energy intake in the intervention group was higher than the control group from day three. Conclusion: Infants after cardiac surgery fed with HF gained more weight but had increased feeding intolerance. However, the feeding intolerance symptoms could be relieved by medication and did not affect feeding advancement. Relevance to clinical practice: Paediatric intensive care clinicians should consider gradually increasing the energy density of the formula during feeding and assess feeding intolerance signs in some children with malnutrition after cardiac surgery. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Nursing-sensitive indicators are considered effective tools for improving the quality of care in hospitals. However, these have not been used in paediatric intensive care units ( PICUs) in China. Aim To develop nursing-sensitive indicators for PICUs and to assess the quality of nursing in PICUs in China based on the nursing-sensitive indicators. Design Multi-centre, cross-sectional study. Methods Structure, process and outcome indicators were developed and measured from 1 January to 31 March 2014 in seven PICUs in China. Results The structure indicators showed that one nurse cared for an average of 2·8 patients in a PICU, and 44% of nurses had a bachelor's degree. The process indicators revealed that hand-washing compliance varied across PICUs, whereas pain management and physical restraint have not been adequately addressed in China. The outcome indicators revealed that the incidence rates of ventilator-associated pneumonia and central-line-associated blood stream infections were 2·96 and 0·7, respectively, per 1000 device days. Patients were intubated for a total of 4392 mechanical ventilator days, and 32 patients (7·29‰) had an unplanned extubation. Nurses were moderately satisfied in their jobs (3·1 ± 0·3), and parents reported that nurses provide high quality of care. Conclusions This study developed and used nursing-sensitive indicators to assess the quality of nursing in PICUs in China, which provided a reference for national and international comparisons of nursing quality in PICUs. Nursing staffing levels and education should be improved. Pain management and physical restraints should be regulated in China's PICUs. Nurse managers need to explore staff attitudes towards implementation of family-centred care. The development of a national database of nursing quality indicators can contribute to quality and safety improvement. Relevance to clinical practice This study developed a set of nursing-sensitive indicators, and these indicators were used to assess and improve the quality of nursing in PICUs. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Stress-induced hyperglycaemia ( SHG) can be observed in as high as 75% of critically ill patients, which can induce severe complications or adverse events. However, conventional intensive insulin therapy ( CIIT) tends to induce hypoglycaemia and glucose variability. Aims This study investigated the clinical effects of a blood glycaemic control optimization programme ( BGCOP) in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery. Design This study is a randomized, controlled, prospective clinical observation. Methods Eighty-six patients with postoperative SHG were randomly divided into a control and experimental groups. Participants in the control group underwent CIIT, while participants in the experimental group underwent blood glycaemic control optimization programme (BGCOP). A range of 7·8-10·0 mmol/L was designated as the target range for effective control of blood sugar. The validity index, adverse events and complications were compared between two groups. Results Compared to participants treated with CIIT, participants treated with BGCOP reached the target range of blood sugar levels more quickly ( p = 0·000). The high glycaemic index ( p = 0·000), incidence of hypoglycaemia ( p = 0·011), and other adverse events as well as the incidence of abdominal infection ( p = 0·026), incision infection ( p = 0·044), and lung infection ( p = 0·047) were significantly lower in participants who underwent the BGCOP than in patients treated with CIIT. Conclusion BGCOP can more effectively control blood sugar levels compared with CIIT in patients with SHG after hepatobiliary or pancreatic surgery. Relevance to clinical practice This study provides a direction for blood glycaemic control in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery. [ABSTRACT FROM AUTHOR]

ABSTRACT Background A healthy work environment can increase nurse-reported job satisfaction and patient care outcomes. Yet the associations between healthy work environment, nurse job satisfaction and QC have not been comprehensively examined in Chinese ICUs. Aim To investigate the mediating effect of nurse job satisfaction on the relationship between healthy work environment and nurse-reported quality of care ( QC) in Chinese intensive care units ( ICUs). Methods A total of 706 nurses were recruited from 28 ICUs of 14 tertiary hospitals. The nurses completed self-reported questionnaires to evaluate healthy work environment, job satisfaction and quality of patient care. Mediation analysis was conducted to explore the mediating effect between nurse-reported healthy work environment and QC. Results Nurse work environment showed positive correlations with nurse-reported QC in the ICUs. Nurse-reported job satisfaction showed full mediating effects between healthy work environment and QC in the medical-surgical ICUs, surgical ICUs and neonatal/paediatric ICUs and indicated a partial mediating effect in the medical ICUs. Relevance to clinical practice Significant mediating effects of nurse job satisfaction provide more support for thinking about how to use this mediator to increase nurse and patient care outcomes. Nurse administrators can design interventions to increase nurse work environment and patient care outcomes with this mediating factor addressed. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To translate and evaluate the psychometric properties of the Essentials of Magnetism II tool ( EOM II) for Chinese nurses in critical care settings. Background The EOM II is a reliable and valid scale for measuring the healthy work environment ( HWE) for nurses in Western countries, however, it has not been validated among Chinese nurses. Methods The translation of the EOM II followed internationally recognized guidelines. The Chinese version of the Essentials of Magnetism II tool (C- EOM II) was reviewed by an expert panel for culturally semantic equivalence and content validity. Then, 706 nurses from 28 intensive care units ( ICUs) affiliated with 14 tertiary hospitals participated in this study. The reliability of the C- EOM II was assessed using the Cronbach's alpha coefficient; the content validity of this scale was assessed using the content validity index ( CVI); and the construct validity was assessed using the confirmatory factor analysis ( CFA). Results The C- EOM II showed excellent content validity with a CVI of 0·92. All the subscales of the C- EOM II were significantly correlated with overall nurse job satisfaction and nurse-assessed quality of care. The CFA showed that the C- EOM II was composed of 45 items with nine factors, accounting for 46·51% of the total variance. Cronbach's alpha coefficients for these factors ranged from 0·56 to 0·89. Conclusions The C- EOM II is a promising scale to assess the HWE for Chinese ICU nurses. Relevance to clinical practice Nursing administrators and health care policy-makers can use the C- EOM II to evaluate clinical work environment so that a healthier work environment can be created and sustained for staff nurses. [ABSTRACT FROM AUTHOR]