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Background: Ethical conflict is embedded in healthcare and is common in critical care setting. However, there is a paucity of research on the nature of ethical conflict in China. Ethical conflict has cultural and context sensitivity. Therefore, evidence is needed from different backgrounds to help discuss this issue across borders. Aim: This study aimed to qualitatively identify the experience of ethical conflict in critical care professionals in China. Study design: From December 2021 to February 2022, we performed semi‐structured, face‐to‐face interviews with 21 critical care professionals from five intensive care units in a tertiary general hospital in China. A thematic analysis approach was used to analyse the data. Results: Five themes and 14 sub‐themes emerged from the data. Critical care professionals probably felt unable to navigate uncertainty, torn by family issues, outraged by unprofessional behaviours of medical staff, being trapped in a socioeconomic dilemma when having experience of ethical conflict. In addition, they also perceived that they could turn struggle into growth. Conclusions: The experience of ethical conflict in critical care professionals involved a mixture of feelings. This study builds a comprehensive understanding of how ethical conflict affected their perceptions of themselves and their profession and provides implications to develop effective coping strategies. Relevance to Clinical Practice: The identification of critical care professionals' experience of ethical conflict would help identify what might trigger the ethical issues and what would be the potential target to optimize in critical practice. [ABSTRACT FROM AUTHOR]

Although pressure ulcers are related to substantial health burdens, they may be preventable. Since nurses play a fundamental role in pressure ulcer prevention, their knowledge and attitude are of great importance. This study aims to investigate the current situation and associated factors of nurses' knowledge and attitude on the prevention of pressure ulcers from both tertiary and secondary hospitals. A total of 11 347 nurses were recruited including 7108 nurses (62.6%) from tertiary hospitals and 4239 nurses (37.4%) from secondary hospitals. The median (interquartile range) of the pressure ulcer knowledge score was 51% (38%, 90%) for all the participants with the lowest scores on prevention of pressure ulcers (51.33%). The mean (standard deviation) of attitude towards pressure ulcer prevention was 39.64 (4.65) with the lowest scores on personal competency to prevent pressure ulcers (mean 3.09). The results of multivariate linear regression showed that hospital level, nurses' age, years of work experience, initial education level at work and time of last training significantly associated with nurses' knowledge of pressure ulcer prevention. Meanwhile, hospital level, job title, previous training, time of last training and subjective needs for further training had significant association with nurses' attitude towards pressure ulcer prevention (all p < 0.05). Results showed inadequate knowledge but relative positive attitudes in nurses indicating the importance to deliver continuing education and training regarding pressure ulcer prevention in practice to improve the quality of care. [ABSTRACT FROM AUTHOR]

Background: The critical conditions and life risk scenarios make intensive care nurses susceptible to ethical conflict. Negative consequences were recognized at both the individual level and the professional level which highly compromised the patient care and nurses' well-being. Therefore, ethical conflict has become a major concern in nursing practice. However, the experience of coping with ethical conflict among intensive care nurses remains unclear. Aims: This study aims to explore the experience of intensive care nurses coping with ethical conflict in China. Methods: From December 2021 to February 2022, in- depth interviews with 15 intensive care nurses from five intensive care units in a tertiary general hospital in China was performed using purposive sampling. An inductive thematic analysis approach was used to analyze the data. We applied the consolidated criteria for reporting qualitative research for this study. Results: Two distinctive themes were found: detachment and engagement, which contained four subthemes: ignoring ethical problems in the workplace, seeking ways to express emotions, perspective-taking, and identifying positive assets. Theses coping strategies demonstrated an ongoing process with different essential features. Conclusion: This study provides a new insight into the experience of intensive care nurses coping with ethical conflict in clinical nursing. Intensive care nurses demonstrated differential experience of coping with ethical conflict including problem-focused, emotion-focused and meaning-making strategies. These findings have implications for policymakers and nursing administrators to develop ethical education and training and supportive environment for intensive care nurses to tackle this issue. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the presence and persistence of antibiotics in wastewater of four typical pharmaceutical manufactories in China and receiving water bodies and suggest the removal of antibiotics by the wastewater treatment process. It also evaluated the environmental impact of antibiotic residues through wastewater discharge into receiving water bodies. The results indicated that thirteen antibiotics were detected in wastewater samples with concentrations ranging from 57.03 to 726.79 ng/L. Fluoroquinolones and macrolides were the most abundant antibiotic classes found in wastewater samples, accounting for 42.5% and 38.7% of total antibiotic concentrations, respectively, followed by sulfonamides (16.4%) and tetracyclines (2.4%). Erythromycin-H2O, lincomycin, ofloxacin, and trimethoprim were the most frequently detected antibiotics; among these antibiotics, the concentration of ofloxacin was the highest in most wastewater samples. No significant difference was found in different treatment processes used to remove antibiotics in wastewater samples. More than 50% of antibiotics were not completely removed with a removal efficiency of less than 70%. The concentration of detected antibiotics in the receiving water bodies was an order of magnitude lower than that in the wastewater sample due to dilution. An environmental risk assessment showed that lincomycin and ofloxacin could pose a high risk at the concentrations detected in effluents and a medium risk in their receiving water bodies, highlighting a potential hazard to the health of the aquatic ecosystem. Overall, The investigation was aimed to determine and monitor the concentration of selected antibiotics in 4 typical PMFs and their receiving water bodies, and to study the removal of these substances in PMFs. This study will provide significant data and findings for future studies on antibiotics-related pollution control and management in water bodies. [ABSTRACT FROM AUTHOR]

Aims: To explore the relationships of ethical climate, physician–nurse collaboration and psychological empowerment with ethical conflict in critical care nurses. Background: Ethical conflict is a major ethical issue in nursing practice. Little research has been done on the associated factors from both organizational and personal perspectives, especially in China. Methods: From October 2021 to March 2022, we collected the data from 342 critical care nurses in three tertiary general hospitals in China via questionnaires about four variables (ethical climate, physician–nurse collaboration, psychological empowerment and ethical conflict). Data were analysed using Spearman's correlation and a structural equation model through statistical product and service solutions (SPSS) and analysis of moment structure (AMOS). Results: Critical care nurses' ethical conflict showed a negative correlation with ethical climate (r = −0.351), physician–nurse collaboration (r = −0.347) and psychological empowerment (r = −0.259) (all p < 0.001). Physician–nurse collaboration partially mediated the relationship between ethical climate and ethical conflict. Additionally, physician–nurse collaboration and psychological empowerment served as sequential mediators in the association. Conclusions: These findings suggested that negative ethical climate can lead to poor physician–nurse collaboration and ultimately ethical conflict. The intermediary role of psychological empowerment and physician–nurse collaboration was also identified. Implications for Nursing Management: Nursing managers should use the study as a fundamental basis to evaluate factors that can affect nurses' ethical conflict and develop effective strategies to mitigate this issue, which may help improve nurses' wellbeing and quality of patient care. [ABSTRACT FROM AUTHOR]

Background: Ethical conflicts are common in the critical care setting, and have compromised job satisfaction and nursing care quality. Using reliable and valid instruments to measure the ethical conflict is essential. This study aimed to translate the Ethical Conflict in Nursing Questionnaire — Critical Care Version into Chinese and determine the reliability and validity in the population of Chinese nurses. Methods: Researchers obtained permission and followed the translation-backward method to develop the Chinese version of the Ethical Conflict in Nursing Questionnaire — Critical Care Version (ECNQ-CCV-C). Relevant psychometric properties were selected according to the Consensus-based standards for the selection of health status measurement instruments checklist. Critical care nurses were recruited from two tertiary public hospitals in Hangzhou, Zhejiang Province, and Kunming, Yunnan Province. Of the 264 nurses we approached, 248 gave their consent and completed the study. Results: The ECNQ-CCV-C achieved Cronbach's alphas 0.902 and McDonald's omega coefficient 0.903. The test-retest reliability was satisfactory within a 2-week interval (intraclass correlation coefficient = 0.757). A unidimensional structure of the ECNQ-CCV-C was determined. Confirmatory factor analysis supported acceptable structure validity. Concurrent validity was confirmed by a moderate relation with a measure for hospital ethical climate (r = − 0.33, p < 0.01). The model structure was invariant across different gender groups, with no floor/ceiling effect. Conclusions: The ECNQ-CCV-C demonstrated acceptable reliability and validity among Chinese nurses and had great clinical utility in critical care nursing. [ABSTRACT FROM AUTHOR]

Purposes: Few studies focus on the mental health of deaf population. This study aims to explore the association between social support and optimism and advance knowledge of why and for whom increased social support was effective. 771 deaf and hard-of-hearing (D/HH) students from two special education colleges in China were investigated. Questionnaires regarding social support, belief about adversity and optimism were distributed online. Multivariate linear regression and structural equation model were performed to examine mediating and moderating effects. This study found that perceived social support was positively associated with optimism in 771 Chinese college students who were D/HH. The study also found that having a belief in being able to face adversity successfully was associated with great social support. The relationship between a positive perspective regarding dealing with adversity and optimism was moderated by gender. For females, a positive belief regarding dealing with adversity was related to optimism. For males there was no relationship between belief about adversity and optimism. Additional consideration needs to be given to those D/HH students who report little social support and to females who do not believe they can successfully overcome adversity. Our study identified the risk population for intervention to improve mental health and well-being in D/HHcommunities. [ABSTRACT FROM AUTHOR]

Background: Transition issues have been discussed for many decades, yet little is known about successful transition expectations in the context of Chinese culture., Purpose: This article was designed to describe the expectations of newly graduated nurses in China regarding successful transition., Methods: A qualitative, descriptive study design was employed, and a purposive sampling method was used to recruit interviewees. All of the one-to-one conversations were held in a quiet room to ensure privacy. All of the interviews were transcribed and then analyzed using thematic analysis., Results: Nineteen new nurses were recruited from seven tertiary hospitals and participated in the in-depth interview process. Transition success, that is, "professional metamorphosis," was revealed through the four themes of "being competent in nursing work," "establishing a professional identity," "establishing comfortable interpersonal relationships," and "achieving balance between work and life.", Conclusions/implications for Practice: Chinese new nurses expect their successful transition to achieve a professional metamorphosis in many aspects. A successful transition is not only a journey of professionalization but also a process of socialization. New nurses expect to achieve both maturity in their work and wisdom in life. The results of this study provide a greater understanding of transition issues in the context of Chinese culture. Thus, support and strategies cannot be limited to interventions designed to improve working competence but should be individualized to help new nurses achieve a smooth transition., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Abstract: Central venous catheters (CVC) are widely used in critically ill patients given their benefits in monitoring vital signs, treatment administration, and renal replacement therapy in intensive care unit (ICU) patients, but these catheters have the potential to induce symptomatic catheter-related venous thrombosis (CRVT). This study reported the rate of symptomatic CRVT in ICU patients receiving CVC and analyzed the disease-related risk factors for symptomatic CRVT in ICU patients.A retrospective analysis was performed on the consecutive ICU 1643 critically ill patients with CVCs inserted from January 2015 to December 2019. Symptomatic CRVT was confirmed by ultrasound. CVCs were divided into 2 groups based on the presence of symptomatic CRVT, and the variables were extracted from the electronic medical record system. Logistic univariate and multivariate regression analyses were used to determine the disease-related risk factors of symptomatic CRVT.A total of 209 symptomatic CRVT events occurred among 2114 catheters. The rate of CRVT was 9.5 per 1000 catheter days. Univariate analysis revealed that trauma, major surgery, heart failure, respiratory failure, and severe acute pancreatitis were risk factors for symptomatic CRVT in the ICU. Multivariate analysis showed that trauma (odds ratio [OR], 2.046; 95% confidence interval [CI] [1.325-3.160], P = .001), major surgery (OR, 2.457; 95% CI [1.641-3.679], P = .000), and heart failure (OR, 2.087; 95% CI [1.401-3.111], P = .000) were independent disease-related risk factors for symptomatic CRVT in ICU. The C-statistic for this model was 0.61 (95% CI [0.57-0.65], P = .000).The incidence rate of symptomatic CRVT in the ICU population was 9.5 per 1000 catheter days. Trauma, major surgery, and heart failure are independent disease-related risk factors of symptomatic CRVT., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The effectiveness of physical restraints (PRs) in the prevention of unplanned extubation has been increasingly questioned, and several countries have developed clinical practice guidelines for reducing the use of PRs. However, some countries, including China, have failed to establish their guidelines, and the adaptation of existing guidelines to local circumstances may be an attractive alternative., Methods: Following the guideline definition of Institute of Medicine, the guideline will be adapted following the CAN-IMPLEMENT©. Guideline scope and clinical questions will be established based on an integrative review, retrospective study, and stakeholder interviews. The guideline's quality will be assessed by the Appraisal of Guidelines for Research and Evaluation II and Appraisal of Guidelines Research and Evaluation-Recommendations Excellence. A systematic review and meta-analysis will be evaluated by A Measurement Tool to Assess Systematic Reviews. The guidelines will meet the criteria of the RIGHT-Ad@pt Checklist., Discussion: This study describes the proposed protocol for adapting clinical practice guidelines on PRs in critically ill patients. We believe the guideline will help health professionals, especially critical care nurses, deliver safe, high-quality patient care by reducing the implementation of PRs in China., Guideline Registration: The guideline has been registered at the International Practice Guidelines Registry Platform (http://www.guidelinesregistry.org/). The registration number is IPGRP-2019CN094, registration date 27-Dec-2019.