Stress hyperglycemia ratio (SHR) refers to the ratio of blood glucose levels to glycated hemoglobin (HbA1c) levels upon admission. As a non-invasive and easily obtainable indicator, there is no systematic evidence-based medical evidence to support the value of SHR in predicting the poor prognosis of critically ill patients at present. PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched with a December 20, 2024 deadline. Prospective and retrospective cohort studies were included. Two investigators independently screened studies and extracted data. The Newcastle–Ottawa scale was applied to appraise the risk of bias in the studies included. Statistical analysis was executed by means of Stata 15.1 software. Study heterogeneity was assessed with the I2 statistic. A restricted cubic spline model was leveraged for dose–response analysis. Sensitivity analyses were implemented to verify the stability of the results using the one-by-one exclusion method, and subgroup analyses were conducted with disease types. 39 studies involving 102,414 patients were included. The meta-analysis revealed that SHR exhibited a noticeable positive link with major adverse cardiovascular events (MACE), 30-day mortality, one-year mortality, cardiovascular mortality (CVM), and all-cause mortality (ACM) in critically ill patients. Dose–response analysis showed that a positive link of SHR with multiple mortality was noted in critically ill patients. SHR is an independent predictor of mortality in critically ill patients, and its dynamic monitoring could provide essential support for early clinical risk stratification and intervention strategies.

Emergency nurses face exceptionally high rates of workplace violence, posing a significant threat to their perceived professional identity. While perceived organizational support and resilience are recognized as potential protective factors, the specific pathways particularly their chain mediating roles linking workplace violence to diminished perceived professional identity among this high-risk group remain inadequately explored and lack empirical validation within the Chinese healthcare context. A convenience sample of 1,804 emergency nurses was recruited from 13 cities across Jiangsu Province, China, during January-March 2024. Participants completed: (1) A Sociodemographic Questionnaire, (2) Workplace Violence Scale, (3) Nurse Organizational Support Scale, (4) Medical Staff Resilience Scale, and (5) Nurse Professional Identity Scale. Structural equation modeling examined the chain mediation of perceived organizational support and resilience on the workplace violence and perceived professional identity among emergency nurses. The results of correlation analysis showed that workplace violence was negatively correlated with perceived organizational support (r=-0.308, P < 0.01), resilience (r=-0.403, P < 0.01) and perceived professional identity (r=-0.454, P < 0.01); perceived organizational support was positively correlated to resilience (r = 0.706, P < 0.01) and perceived professional identity (r = 0.736, P < 0.01); and resilience was positively correlated with perceived professional identity (r = 0.783, P < 0.01). The total effect coefficient, direct effect coefficient, and indirect effect coefficient of workplace violence and perceived professional identity are “−0.493”, “−0.067”, and “−0.426”, respectively; the indirect effect accounts for 86.41% of the total effect. Among the indirect effects, the specific mediating effects of perceived organizational support and resilience account for 21.50% and 21.10%, respectively, and the chain mediating effects of perceived organizational support and resilience account for 44.02%. Workplace violence not only directly harms the perceived professional identity of emergency nurses but also indirectly affects it through the chain mediation of perceived organizational support and resilience. Nursing managers should establish a multi-level intervention system, including strengthening organizational support and enhancing nurses’ resilience, to improve the perceived professional identity of emergency nurses. Not applicable.

Background: Missed nursing care (MNC) is prevalent in ICU settings and may negatively impact patient outcomes while increasing the professional burden on nurses. Although many studies have explored the causes and consequences of missed care, a systematic qualitative synthesis that illuminates the critical link between them is still lacking. Specifically, the decision‐making mechanisms in ICU nurses employ under systemic pressures, and how these mechanisms lead to specific care elements being omitted. Aim: This meta‐synthesis aims to synthesise qualitative evidence to systematically analyse and illuminate the determinants, processes and multifaceted impacts of missed nursing care (MNC) in the ICU. Study Design: The qualitative meta‐synthesis was conducted in accordance with the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA). We searched 10 major databases (including PubMed, Web of Science, CINAHL, CNKI, etc.) from their inception to June 2025. Two reviewers independently assessed the methodological quality and extracted data. Thematic synthesis was used to integrate and analyse the findings. Findings: Six studies satisfied the inclusion criteria. The meta‐synthesis identified the following six core themes: (1) nurses' divergent views of missed nursing care, (2) the convergence of multilevel systemic pressures behind missed care, (3) the decision‐making mechanism: nurses' strategic adaptations, (4) commonly missed elements of nursing care, (5) the cascading consequences of missed care and (6) nurses' perceived organisational‐level interventions. Conclusions: This meta‐synthesis identified six core themes, revealing that ICU missed nursing care (MNC) is a predictable, system‐driven process. The findings demonstrate that multilevel systemic pressures compel nurses to activate strategic decision‐making mechanisms to safeguard patient safety. However, the direct product of this mechanism is the omission of low‐priority nursing measures, such as basic and psychosocial care. This omission, in turn, triggers adverse consequences for nurses, patients and the entire healthcare system. A key implication of this study is that MNC should not be attributed to personal failings but is a structural problem rooted in these systemic pressures. Therefore, managers must address this situation by implementing organisational‐level interventions that target these root causes, thereby reducing missed care, improving clinical quality and genuinely enhancing patient and nurse satisfaction. Relevance to Clinical Practice: These findings provide clear directives for ICU managers. Therefore, the managerial focus must shift. Instead of ‘policing’ or punishing the rational prioritisation decisions nurses make under pressure, managers must redirect resources and energy towards solving the two root issues: (1) addressing the systemic pressures that force these decisions and (2) mitigating the emotional and moral distress that results from them. Trial Registration: The protocol of this qualitative meta‐synthesis has been registered at PROSPERO with the identifier CRD420251063358

The emergency department (ED) is one of the places where patient deaths frequently occur. Understanding family members' experiences of bereavement would help provide individualized bereavement care. We conducted a meta-synthesis to synthesize family members' experiences of bereavement in the ED and assess the impact of bereavement on their lives. We searched seven international electronic databases. Five studies were selected and critically appraised. Thematic analysis was employed. Five themes (with 13 subthemes) were derived: suffering sudden changes and are severely impacted, multiple feelings and needs of waiting, final farewell, personal and family difficulties after leaving the ED, and journey through grief. Family members endured agonizing waits to see and learn more about their family members' condition. Family members reported the need for effective follow-up resources. Findings revealed that it would be helpful if the EDs could provide sensitive and respectful care to family members.