Yiyu Zhuang

Correction on: Dong J, Ni Q, Gong X, Sui W, Wang L, Huang Z, Yi J, Yan R, Jiang W, Zhou H, Zhang J and Zhuang Y (2026) A virtual reality-based multicomponent intervention program for preventing postoperative delirium in the intensive care unit for cardiac surgery patients: from evidence-based design to a pilot trial. Front. Med. 13:1815659. doi: 10.3389/fmed.2026.1815659.Wrong content There was a mistake in Table 1 as published. In the sedative medication use rows of Table 1. Baseline data of the participants, the codes for "None" were reversed during data entry, and the percentages were calculated using an incorrect denominator. The corrected Sedative medication use rows in Table 1 appears below.

Background: Intensive care unit nurses face sustained workload, vigilance and emotionally demanding care. Psychological detachment during non‐work time is an important recovery experience, but evidence in this population remains limited. Aim: To describe psychological detachment among intensive care unit nurses and identify demographic, departmental psychological support resources availability, social support and burnout dimensions associated with it. Study Design: A single‐centre cross‐sectional survey. Registered intensive care unit nurses from a tertiary grade A general hospital in eastern China were recruited by convenience sampling between June and July 2025. Participants completed demographic, psychological detachment, burnout and social support questionnaires. Descriptive analyses, univariate comparisons, correlation analyses and multivariable linear regression were performed. The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Results: Of 220 questionnaires submitted, 199 valid responses were analysed (90.45%). The mean psychological detachment score was 11.68 ± 3.85. Mean emotional exhaustion, depersonalisation and personal accomplishment scores were 37.75 ± 8.15, 16.93 ± 4.87 and 25.91 ± 6.25, respectively. Psychological detachment correlated negatively with emotional exhaustion ( r = −0.230, p = 0.001) and positively with subjective support ( r = 0.175, p = 0.013). Departmental psychological support resources availability (B = 1.674, β = 0.216, p = 0.001), head‐nurse position (B = −4.776, β = −0.195, p = 0.004) and emotional exhaustion (B = −0.115, β = −0.243, p < 0.001) were independently associated with psychological detachment. Conclusion: In this single‐centre sample of intensive care unit nurses, the reported availability of departmental psychological support resources was associated with higher psychological detachment, whereas head‐nurse position and emotional exhaustion were associated with lower psychological detachment. Relevance to Clinical Practice: These findings suggest that critical care nursing managers may consider departmental psychological support resources availability, nursing position and emotional exhaustion when assessing recovery needs among intensive care unit nurses.

Objective: To investigate the current status and influencing factors of self-care among chronic heart failure (CHF) patients and their spouses in China from a dyadic perspective, and to explore the interaction mechanisms between actor and partner variables. Methods: Using a cross-sectional design, 204 dyads of CHF patients and their spouses were recruited from a tertiary hospital in Zhejiang Province. Data were collected via an online questionnaire platform, with trained investigators assisting elderly participants unable to complete the survey on their own. Questionnaires used in this study included the general information questionnaire, Self-Care of Heart Failure Index, Health Literacy Scale, Mutuality Scale, and Social Support Rating Scale. Data were analyzed using multiple linear regression and the Actor-Partner Interdependence Model. Results: Median scores of all three self-care subscales for both patients and spouses were below the adequacy threshold of 70 points, with the Self-care Management dimension presenting the lowest subscale scores. Patient self-care scores were significantly higher than spouse contribution scores ( P < 0.001). Multiple regression indicated that mutuality and CHF training experience were positively associated with self-care for the dyads. APIM analysis revealed that patient health literacy and spouse mutuality had significant actor-partner effects, influencing both their own and their partner's self-care. Conclusion: Self-care levels in CHF dyads were generally low. Clinical interventions should shift from an individualistic focus to a dyadic approach, specifically targeting the enhancement of patient health literacy and spouse mutuality to improve overall family-based disease management.

Aim: To develop and internally validate prediction models estimating the individual probability of high decisional regret at 6 months among family surrogate decision-makers (FSDMs) of intensive care unit (ICU) patients, and to compare regression-based and machine-learning approaches with respect to discrimination, calibration and clinical utility. Design: A single-center prospective cohort study for the development and internal validation of prediction models. Methods: This single-center observational prediction-model study was conducted in five ICUs of a tertiary university-affiliated hospital in Hangzhou, China, from October 2023 to October 2024. We enrolled 336 family surrogate decision-makers. Sociodemographic characteristics, health literacy, eHealth literacy, anxiety, depression, trust in physicians, and family functioning were collected within 3 days after ICU discharge. Decisional regret was assessed 6 months after hospital discharge using the Decision. Regret Scale and analyzed as a binary outcome, with a transformed score of ≥25 defining high decisional regret. Candidate predictors were selected using univariate analysis and least absolute shrinkage and selection operator regression. Logistic regression, random forest, support vector machine, and extreme gradient boosting models were developed and internally validated using a 70:30 train-test split. Model performance was assessed by discrimination, calibration, and decision curve analysis. SHAP analysis was used as an exploratory interpretability method. Results: Among 336 family surrogate decision-makers, 165 (49.11%) had high decisional regret and 171 (50.89%) had low decisional regret. Univariate analysis identified nine variables associated with decisional regret, including health literacy, trust in physicians, patient survival status, relationship to the patient, household income, anxiety, depression, and family functioning (all p < 0.05). In the test set, logistic regression showed the strongest overall performance (AUC 0.875, 95% CI 0.808–0.942; accuracy 0.752; sensitivity 0.702; specificity 0.796; F1 score 0.725). It also showed the most stable calibration and clinical net benefit. The final model comprised five predictors: eHealth literacy, trust in physicians, average monthly household income, anxiety and depression. In a secondary explanatory analysis, each contributed independently to the predicted probability (all p < 0.05); these estimates are reported to aid interpretation of the model and are not intended as causal effect estimates. Exploratory SHAP analysis identified trust in physicians, anxiety, and eHealth literacy as prominent contributors to model predictions. Conclusion: Decisional regret was common among ICU family surrogate decision-makers. Trust in physicians, eHealth literacy, household income, anxiety, and depression were key predictors. Among the candidate models, logistic regression provided the best balance of discrimination, calibration, and clinical utility, suggesting that a parsimonious and interpretable model may support early risk screening in ICU family-centered care.

Background: When the goals of care for a critically ill child in the pediatric intensive care unit (PICU) shift from curative treatment toward palliative care, parents’ experiences are often complex and multifaceted. This review aimed primarily to synthesize qualitative evidence on parents’ experiences and, secondarily, to examine the interpretive relevance and boundaries of Weick’s sensemaking framework after the data-driven synthesis had been completed. Methods: We conducted a qualitative systematic review using the Joanna Briggs Institute (JBI) meta-aggregation approach. PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, and ProQuest were searched from inception to 2 February 2026. Two reviewers independently screened studies, extracted author-generated analytical findings and supporting participant illustrations, and appraised methodological quality. Findings were synthesized inductively; the 15 resulting subdomains were subsequently mapped to Weick’s seven properties of sensemaking. Results: Ten studies were included. Meta-aggregation generated five interrelated synthesized findings: (1) confronting and understanding the end-of-life reality; (2) finding recognition and support through relational networks; (3) maintaining the parental role; (4) safeguarding comfort, dignity, and farewell; and (5) continuing care and connection after the child’s death. Conclusions: Parents’ experiences encompassed efforts to understand a changing clinical situation, rely on relationships with clinicians and others, remain involved as parents, protect the child’s comfort and dignity, and sustain connection after death. Weick’s framework helped interpret how parents used clinical cues, relationships, identity, and caregiving actions to construct a workable understanding of events, but gave less attention to grief-related emotions, surrogate decision-making burden, cultural and spiritual meaning, organizational constraints, and continuing bonds. The findings may inform family-centered communication, parental-role support, individualized end-of-life care, and bereavement services in the PICU.

Objective: This study aimed to investigate the factors influencing self-care among older patients with heart failure (HF) and their spouses from a dyadic perspective. Methods: An explanatory sequential mixed-methods design was employed. In the quantitative phase, 145 dyads of older HF patients and their spouses were recruited from a tertiary hospital in Zhejiang, China. Validated instruments were used to measure patient self-care, spouse contribution to self-care, disease-specific health literacy, mutuality, and social support. Multiple linear regression and the Actor-Partner Interdependence Model (APIM) were conducted separately for three self-care subscales (maintenance, management, confidence). In the qualitative phase, 10 dyads were purposively sampled for one-to-one semi-structured interviews, and data were analyzed via Colaizzi’s phenomenological method. Quantitative and qualitative findings were integrated adhering to the Theory of Dyadic Illness Management (TDIM). Results: Both patients and spouses scored below the 70-point adequacy threshold across all three self-care subscales. APIM revealed significant actor effects of health literacy and mutuality on self-care for both dyad members. Significant partner effects were observed in two dimensions: spouse mutuality was positively associated with patient self-care maintenance ( B = 5.352, 95% CI: 0.631–9.828, p = 0.027), and spouse health literacy was positively associated with patient self-care confidence ( B = 0.364, 95% CI: 0.193–0.533, p < 0.001). No significant partner effect was detected in the self-care management dimension, which showed suboptimal model fit and was thus interpreted as exploratory. No significant paths of traditional social support were retained in final models. Qualitative findings identified four thematic levels (individual, dyadic, family/social, cultural), supplementing contextual factors such as economic burden, reliance on digital healthcare services, and neglect of spousal caregivers. The integration provided a plausible contextual hypothesis for the null quantitative association between traditional social support and self-care. Conclusion: Health literacy and mutuality are core correlates of self-care among older Chinese HF patient-spouse dyads, with dimension-specific dyadic interaction patterns. Clinical interventions should develop tailored dyadic support strategies for distinct self-care dimensions, and pay attention to optimizing age-friendly digital healthcare services and improving caregiving culture. This study provides exploratory evidence for context-specific extension of the TDIM framework.

Aims: This meta‐synthesis of qualitative studies aimed to explore the experiences and perspectives of healthcare providers in the Intensive Care Unit (ICU) setting regarding the implementation of early mobilization. Design: A qualitative systematic review and meta‐synthesis was conducted. The review protocol was registered with PROSPERO (CRD420251057721). Data Sources: Six databases (PubMed, EMBASE, Web of Science, CINAHL, CNKI and Wanfang Data) were searched from inception to March 5, 2025. A total of 759 records were identified, and 34 studies met the eligibility criteria and were included in the final meta‐synthesis. Review Methods: We evaluated the quality of the included studies using the Critical Appraisal Skills Programme‐Qualitative Research Checklist. Results: Thirty‐four studies conducted in 13 countries and involving 699 ICU healthcare providers were included. Four analytical themes were generated: characteristics of early mobilization, the inner setting of implementation, the key role system and core determinants of successful implementation. Conclusion: Early mobilization in ICUs should be understood as a multidimensional implementation process rather than a single rehabilitation task. Sustainable practice depends on the characteristics of the intervention, organizational readiness, clearly defined interprofessional roles, patient engagement and process‐level strategies such as preplanning, real‐time monitoring, debriefing and feedback. The findings support the development of context‐sensitive implementation strategies to translate early mobilization evidence into routine ICU care. Impact: This review underscores the critical importance of organizational support, team collaboration mechanisms and the professional capacity building of healthcare providers in advancing early mobilization within ICU settings. Frontline clinicians should be equipped with targeted training and structured planning tools, while leadership is encouraged to foster a culture of shared responsibility and continuous improvement. Patient or Public Contribution: This qualitative systematic review did not involve original patients or the public. Therefore, this is not applicable.

Objective: To explore intensive care unit (ICU) healthcare professionals’ perceptions and experiences of shared decision-making with conscious patients. Design: A qualitative descriptive study using semistructured interviews. Setting: Three ICUs at a Joint Commission International-accredited hospital in Hangzhou, Zhejiang Province, China. Participants: 16 ICU healthcare professionals (9 females, 7 males; aged 23–45 years) were interviewed between September and November 2024. Results: We identified 10 subthemes that were classified into three themes: (a) conscious but not ready: unstable decision-making ability, insufficient emotional readiness and limited cognitive evaluability; (b) the roles of doctors and nurses in shared decision-making (SDM): physicians as advisors, not decision-makers, nurses’ limited role in SDM and fragmented team communication hinders information flow and (c) the double-edged sword of patient participation: protection or blame, collaboration or burden, hope or harm and being caught between values. Conclusions: ICU healthcare professionals acknowledge the value of involving conscious patients in SDM but also recognise its complexity. Challenges include assessing patients’ fluctuating decision-making capacity, poor team communication and the potential for both benefit and harm. These findings highlight the need for clearer professional roles and more structured support.