Background: Post Intensive Care Syndrome (PICS) is a set of physical, cognitive, and mental health symptoms that arise following intensive care (ICU) hospitalization. Regarding physical changes, muscle weakness is highlighted, potentially leading to functional impairments during and after hospitalization. Multidisciplinary guidelines recommend early mobilization, a rehabilitation intervention, as a strategy to prevent ICU-acquired muscle weakness and reduce functionality impairments. Objective: This study aims to evaluate the effectiveness of early mobilization and positioning interventions to prevent or minimize ICU-acquired weakness in critically ill patients under invasive mechanical ventilation (IMV). Methods: A systematic review of effectiveness will be conducted following Cochrane recommendations. Searches will be made in MEDLINE (via PubMed), CINAHL, Scopus, and Web of Science. Eligible studies will include randomized controlled trials on the functional management of muscle weakness, muscle strength, and ICU-acquired muscle weakness in adults (≥18 years) who have undergone IMV. Eligible interventions (and comparators) include any manual mobilization and positioning strategy or the use of medical devices. Two reviewers will independently select studies, extract data using a piloted tool and assess bias with the RoB 2 tool. If appropriate, a meta-analysis will be conducted, pooling standardized mean differences using a random-effects model. Results: This review included primary experimental studies manipulating at least one variable, control group studies, or randomized trials comparing early intervention protocols, programs, or plans with standard care or existing approaches in the ICU. Conclusions: This review will provide meaningful comparisons of different mobilization and positioning strategies, evaluating their impact on muscle strength and functionality in critically ill patients. Systematic Review Registration: PROSPERO CRD4202348091.

Background: Simulated critical care training, when complemented by structured debriefing that addresses affective, psychosocial, and cognitive domains, provides a solid foundation for developing critical thinking and decision-making skills among nursing students. Structured debriefing serves not only as a mechanism for reflective practice but also as an evidence-based instructional methodology that optimizes experiential learning. This study aims to evaluate the impact of structured debriefing conducted post-simulation, on the acquisition and development of essential nursing competencies in undergraduate students. Methods: A descriptive cross-sectional study with a quantitative design was conducted, involving a cohort of 71 fourth-year nursing students enrolled in the curricular unit “Critical Care Nursing”. The sample comprised a single class that participated in two high-fidelity clinical simulation sessions, each immediately followed by a structured debriefing session. After each simulation, students completed the Debriefing Assessment Scale Associated with Simulation (EADaS), which evaluates three domains of the debriefing experience: affective, cognitive, and psychosocial. Results: Students expressed an overall positive perception of the debriefing sessions. In the first evaluation, the affective dimension received the highest mean score (4.687), despite some variability in individual responses. By the second evaluation, the cognitive dimension attained the highest score (4.668), suggesting an enhanced perception of knowledge integration. Both cognitive and psychosocial dimensions demonstrated marked improvement between the two assessment moments. Conclusions: The findings underscore the essential role of structured debriefing in simulated critical care training, particularly in fostering emotional safety, critical reflection, and interpersonal competence. As such, structured debriefing stands out as a vital pedagogical approach in preparing nursing students to become confident, competent, and reflective practitioners, thereby contributing to improved patient safety and care outcomes.

Cultural collaboration can support a more holistic approach to nursing care in managing complex conditions, such as pressure ulcers. This study aimed to evaluate the effects of multiplayer, interactive, and noninteractive virtual patient simulations on knowledge, effectiveness, satisfaction, and self-confidence regarding pressure ulcer management among Portuguese and Turkish nursing students. The quasi-experimental, pre-posttest design study was conducted between March and July 2025; data were obtained from 52 nursing students (Experimental Group: 26; Control Group: 26) in Turkey and Portugal using the “Personal Profile Form,” “Pressure Ulcer Prevention Knowledge Assessment Instrument,” “Simulation Effectiveness Tool-Modified,” “Student Satisfaction and Self-Confidence in Learning Scale,” and “Structured Debriefing Questionnaire.” Between-group comparisons of “Pressure Ulcer Prevention Knowledge Assessment Instrument” posttest scores revealed significant differences in the “Preventive Measures to Reduce the Duration of Pressure/Shear” subscale and total scores. Within the experimental group, pre-post comparisons revealed significant moderate improvements in the same subscale and total scores. “Simulation Effectiveness Tool-Modified” pre-post comparisons in the experimental group showed significant improvements in “ Learning ,” “ Confidence ,” “ Debriefing ” subscales, and total scores. “Student Satisfaction and Self-Confidence in Learning” scores improved significantly only in the experimental group. Qualitative data analysis identified themes, including Clinical Competence and Skill Acquisition, Reflective Practice, Communication and Collaborative Practice, Simulation Fidelity and Challenges, Confidence and Clinical Readiness , and Affective Response to Simulation. This study demonstrates that multiplayer, interactive virtual patient simulation is associated with improvements in nursing students’ knowledge, perceived simulation effectiveness, and satisfaction in pressure injury management.

Simulation is increasingly recognised as a strategic approach in nursing education for developing clinical competencies within safe learning environments. However, there is limited understanding of how virtual patient simulation supports the early development of clinical reasoning from the perspective of nursing students. Aim: To explore the perceptions of first-year undergraduate nursing students regarding the development of clinical reasoning and collaborative decision-making through virtual patient simulation. Methods: A qualitative, descriptive, and exploratory design was adopted. Semi-structured focus groups were conducted with 73 first-year undergraduate nursing students. Data were analysed using thematic content analysis following Bardin’s approach. Results: Students perceived virtual patient simulation as a meaningful and high-impact learning strategy. Realism, interactivity, and group collaboration emerged as key strengths. Engagement with dynamic clinical scenarios supported the integration of theoretical knowledge into practice, enhanced prioritisation skills, and promoted structured clinical reasoning. Collaborative learning facilitated shared reflection and collective problem-solving, while immediate feedback enabled learning through error within a psychologically safe environment. Participants also reported increased confidence and autonomy in decision-making. At the same time, students identified limitations related to software constraints and the alignment between automated assessment and their reasoning processes. Conclusions: Group-based virtual simulation appears to support the early structuring of clinical reasoning, extending beyond technical skill acquisition to foster reflective and collaborative practice. Its educational value, however, depends on intentional curricular integration and strong pedagogical alignment including structured facilitation, alignment between assessment and learning objectives, and opportunities for guided reflection. These findings contribute to a process-oriented understanding of how novice learners make sense of clinical reasoning in simulated contexts.