With the development of virtual reality (VR) technology and wide application of simulation-based medical education in clinical teaching, VR has been attracting growing attention in the field of simulation teaching in pediatrics. Studies have shown that VR technology can effectively improve pediatric clinical teaching effects by providing an immersive learning environment and enhancing the learning experience of students. VR also expands the teaching methods of pediatric simulation education. This paper discusses the application of VR technology in virtual standardized patients, simulation teaching of clinical practice skills, and clinical scenario simulation in pediatrics, as well as the use of ACEP SimBox in VR simulation teaching in pediatric emergency care. Future research needs to focus on the further development of VR technology and its application in simulation teaching, and find the best way to combine VR with traditional teaching methods.

Critically ill patients are at high risk for hospital acquired infections, which can significantly increase the mortality rate and treatment costs for these patients. Therefore, in the process of treating the primary disease, strict prevention and control of new hospital infections is an essential component of the treatment for critically ill patients. The treatment of critically ill patients involves multiple steps and requires a concerted effort from various aspects such as theory, management, education, standards, and supervision to achieve effective prevention and control of hospital infections. However, there is currently a lack of unified understanding and standards for hospital infection prevention and control. To address this, in March 2024, a group of experts in critical care medicine, infectious diseases, and hospital infection from China discussed the current situation and issues of hospital infection control in the intensive care unit together. Based on a review of the latest evidence-based medical evidence from both domestic and international sources, 2024 Expert Consensus on Hospital Acquired Infection Control Principles in the Department of Critical Care Medicine was formed, aiming to provide a basis for the development of hospital infection prevention and control strategies in the field of critical care medicine.

Objective:To explore the relationship between serum urea nitrogen to creatinine ratio (UCR) and cardiac function in elderly patients with severe pneumonia.Methods:A prospective selection of 100 elderly patients with severe pneumonia admitted to Group Wanbei General Hospital of Wanbei Coal Power from May 2020 to April 2023 was conducted as the case group, and an additional 50 patients who underwent health examinations in the hospital during the same period were selected as the control group. Serum urea nitrogen (BUN), creatinine (Cr), UCR value, myocardial injury indexes: cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-ProBNP), creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), and cardiac function indexes: left ventricular ejection fraction (LVEF), cardiac output (CO), stroke volume (SV) and cardiac output index (CI) were detected in the two groups. The patients in the case group were divided into two subgroups based on the occurrence of heart failure during hospitalization: the heart failure subgroup and the normal heart function subgroup. The serum UCR, myocardial injury and cardiac function indexes were compared between the case group and the control group. The general data, myocardial injury and cardiac function indexes were compared between the heart failure group and the normal heart function group. The relationship between serum UCR and cardiac function in patients with severe pneumonia was analyzed by bivariate Pearson correlation. Logistic regression model was used to analyze the influencing factors of cardiac dysfunction in patients with severe pneumonia, and using receiver operating characteristic (ROC) curve to analyze the value of serum UCR in predicting cardiac dysfunction in patients with severe pneumonia.Results:The values of BUN, UCR, cTnI, NT-ProBNP, CK and CK-MB in the case group were higher than those in the control group: (8.72 ± 1.14) μmol/L vs. (6.41 ± 0.76) μmol/L, 125.00 ± 19.75 vs. 86.12 ± 12.02, 0.04 (0.03, 0.05) μg/L vs. 0.04 (0.03, 0.05) μg/L, (185.49 ± 20.59) ng/L vs. (147.76 ± 20.85) ng/L, (104.78 ± 14.98) U/L vs. (99.33 ± 15.07) U/L, (31.59 ± 6.23) U/L vs. (29.13 ± 5.76) U/L. The values of Cr, LVEF, CO, SV and CI in the observation group were lower than those in the control group: (70.22 ± 5.76) μmol/L vs. (74.75 ± 5.12) μmol/L, (59.72 ± 2.41)% vs. (61.78 ± 2.16)%, (3.93 ± 0.43) L/min vs. (4.53 ± 0.62) L/min, (59.82 ± 6.12) ml vs. (62.23 ± 7.22) ml, (2.95 ± 0.30) L/(min·m 2) vs. (3.06 ± 0.33) L/(min·m 2), with a statistical significant difference ( P<0.05). In the case group, 21 patients had heart failure during hospitalization, accounting for 21.00%. The pneumonia severity index score on admission in the heart failure subgroup was higher than that in the normal heart function subgroup: (172.76 ± 9.18) points vs. (168.24 ± 8.81) points. The serum BUN and UCR levels were higher than those in the normal heart function subgroup: (9.51 ± 0.79) mmol/L vs. (8.51 ± 1.13) mmol/L, 141.62 ± 9.89 vs. 120.59 ± 19.39. The serum Cr level was lower than that in the normal heart function subgroup: (67.26 ± 5.34) μmol/L vs. (71.00 ± 5.65) μmol/L, with a significant statistical difference ( P<0.05). There was no significant statistical difference in other data between the two subgroups ( P>0.05). The bivariate Pearson correlation analysis showed that serum UCR was positively correlated with cardiac function indicators cTnI, NT-ProBNP, CK and CK-MB levels in severe pneumonia ( r = 0.40, 0.27, 0.32 and 0.33; P<0.05), and negatively correlated with LVEF, CO, SV and CI levels ( r = - 0.37, - 0.21, - 0.25 and - 0.21; P<0.05). Univariate and multivariate Logistic regression analysis showed that the occurrence of cardiac dysfunction in elderly patients with severe pneumonia may be related to the pneumonia severity index score on admission and the abnormal expression of serum BUN, UCR and Cr levels ( P<0.05). ROC curve analysis found that the area under the curve for predicting the occurrence of cardiac dysfunction during hospitalization in severe pneumonia patients with serum UCR on admission was 0.85 (95% CI 0.77 to 0.92), which had certain predictive value. Conclusions:Elderly patients with severe pneumonia are accompanied by a certain degree of elevated serum UCR levels, and the higher the serum UCR level, the more severe the cardiac function damage and the greater the risk of cardiac dysfunction.

Purpose: : Intensive care unit (ICU) diaries have been implemented across the international ICU community. This study aimed to comprehend the meaning and nature of the lived experience of patients’ families using the ICU diary in Korea. Methods: : This qualitative study adopted van Manen’s hermeneutic phenomenology. The participants comprised eight women and two men who were the family members of patients in the ICU for more than three days. Data were collected using in-depth interviews and observation from July 2018 to January 2019. Results: : Patients’ families who experienced the ICU diary recognized it with six beings according to time: a good idea, forgotten stuff, burdensome work, touching service, my stuff, and a thing in the memory. The ICU diary had three essential meanings for the families: communication, solace and hope, and a record of life. These findings were rearranged according to van Manen’s fundamental existential, and the lived things and lived others were remarkably confirmed. Conclusion : Patients’ families experienced various ICU diary forms over time and recognized an ICU diary as a means of communication. Therefore, the ICU diary is expected to be used as an intervention between families and healthcare providers in the ICU to support mutual communication.

Purpose: : The purpose of this study was to not only examine the importance and performance status of patient safety nursing activities in the intensive care unit but also to understand nurses’ educational needs in this respect. Methods: : In this descriptive study, 196 nurses working in the intensive care units of university hospitals located at B City and G Province were enrolled. They completed the Importance–Performance Analysis (IPA) questionnaire, and the data were statistically analyzed. Results: : Mean±standard deviation item scores of importance and performance of patient safety nursing activities were 4.75±0.33 and 4.48±0.38, respectively. In the IPA results, a total of 10 items were included in the second quadrant, including 1 item related to ‘transfer,’ 1 to ‘infection,’ and 1 to ‘firefighting surveillance.’ As the second quadrant contains the high-importance, low-performance items, these 10 items resemble the nurses’ educational needs that should be prioritized. Conclusion : The results of this study can be used as a basis for the development of nursing educational programs for patient safety in the intensive care unit.

Objective:To investigate the effect of ICU nurses-led procedural sedation and analgesia (PSA) regimen in critically ill patients after liver transplantation.Methods:Using the convenient sampling method, a total of 140 critically ill patients after liver transplantation who were admitted to the surgical ICU of Beijing Chaoyang Hospital from January to December 2019 were selected as the research objects. According to the random number table method, the patients were divided into the experimental group and the control group, with 70 cases in each group. The control group was given routine analgesia and sedation, while the experimental group was given a self-designed PSA program on the basis of the control group. The dosage of analgesic and sedative drugs, incidence of complications, length of mechanical ventilation and length of ICU stay in 2 groups were recorded and compared.Results:The per capita dose of analgesic and sedative drugs in the experimental group was lower than that in the control group, and the difference was statistically significant ( P<0.01) . The duration of mechanical ventilation, the duration of ICU stay and the incidence of delirium in the experimental group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The use of PSA in critically ill patients after liver transplantation can reduce the dosage of sedative and analgesic drugs, shorten the duration of mechanical ventilation and ICU stay and reduce the incidence of delirium.

Objective:To explore the effect of general clinical training on core competence, ICU knowledge and skills of ICU nurses.Methods:Using the convenient sampling method, a total of 32 nurses from various specialties who worked in ICU of Beijing Chaoyang Hospital from February to March 2020 were selected for ICU general clinical practice training. The core competencies of ICU nurses were evaluated by the ICU nurse professional core competencies questionnaire before and 1 month after the training, including the ability to master and apply ICU setting and management, the ability to master and apply critically ill patient care, the ability to master and apply specialized technical skills, and the ability to educate and train. ICU theoretical knowledge and operation skills were assessed by using self-made theoretical knowledge examination papers and operation assessment standards. Paired t test and paired χ 2 test were used for statistical analysis. Results:After the general clinical training, the proportion of 32 nurses who scored good in 16 items in the evaluation of core competence was higher than before (χ 2= 4.571-6.583) . Among the four dimensions of core competence, the score of master and apply ICU setting and management was higher than that before training ( t=-2.442) . The difference was statistically significant ( P<0.05) . After training, theoretical knowledge score of nurses ( t=-9.500) and operational skills score ( t=-2.590) were improved, and the differences were all statistically significant ( P<0.05) . Conclusions:The general clinical training can improve ICU nurses' ability to master and apply ICU setting and management and their knowledge and skills of general intensive care, so as to provide a certain basis for the reserve of general ICU nursing team for future public health emergencies.

Objective:To observe the effect of positive psychological intervention based on PERMA model on core emergency competence and empathy of ICU nurses in infectious disease emergencies.Methods:From February to April 2020, a total of 136 ICU nurses from 3 ClassⅢ Grade A hospitals in Beijing were selected as the research objects. The patients were divided into the control group and the experimental group by the random number table method, with 68 cases in each group. The control group was given professional knowledge training, while the experimental group was given professional knowledge training combined with PERMA positive psychological intervention. The core emergency competence and compassion load of ICU nurses in the two groups before and after intervention were compared by using the Core Emergency Competence Questionnaire for Infectious Disease Emergencies and Nurses' Compassion Load Scale.Results:After intervention, scores of emergency competence of nurses in both groups were higher than before intervention, and the score of emergency competence in the experimental group was higher than that in control group, and the differences were statistically significant ( P<0.05) . After the intervention, the scores of the satisfaction subscale of helping and caring for others in Nurses' Compassion Load Scale in the experimental group were higher than those before the intervention, and the subscale scores of burnout and compassion fatigue were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Positive psychological intervention based on the PERMA model can effectively increase the core emergency competence of ICU nurses in infectious disease emergencies and reduce their psychological load.

Enteral nutrition is an indispensable part of the treatment for critically ill patients. Various authoritative guidelines point out that early enteral nutrition is the key to improve the prognosis of disease. The key to improve and promote standardized enteral nutrition for criti-cally ill patients is the application of guidelines in the clinical practice. Based on clinical practice and theoretical basis, the authors propose a new insight into enteral nutrition and a new nutritional strategy of "individual treatment, circular evaluation, channel basis, quality-quatity balance, step-up achievement" for critically ill patients on basis of a 5W1H mindset.

Because of the widespread development and application of rapid response system (RRS) in medical institutions in developed countries, such as Europe, America and Australia, the clinical adverse events (cardiac arrest, accidental death, etc.) in hospital patients have been reduced and improved. Meanwhile, the hospitalization rate and mortality rate of intensive care unit in hospital patients have been reduced, thus shortening the hospitalization time and reducing the medical expenses. Nevertheless, RRS is still in the exploration stage in our country. Therefore, the article reviews the RRS model and application development.