Enhancing Critical Thinking Competency and Nursing Quality in Critically Ill Patient Care

Enhancing Critical Thinking Competency and Nursing Quality in Critically Ill Patient Care: A Quasi-Experimental Study of an Evidence-Based Nutritional Management Protocol

The EBN-based nutritional management protocol effectively enhances junior nurses' specialized critical thinking competency and improves patient nutritional outcomes and satisfaction, demonstrating its potential to optimize critical care quality. However, further validation through multicenter studies with larger cohorts, extended follow-up periods, and additional outcome measures is warranted.

Study Overview

• Status: Completed
• Conditions: Training; Critically Ill Patient; Evidence-Based Nursing
• Intervention / Treatment: Other: Conventional group; Other: evidence-based nursing group

Detailed Description

This study aims to develop an evidence-based nursing (EBN)-based nutritional management protocol for critically ill patients and assess its effects on junior nurses' specialized critical thinking competency and nursing quality. A quasi-experimental design was employed, involving 7 junior nurses and 84 critically ill patients in each of the study and control groups. The study group implemented the EBN-based protocol alongside structured training, while the control group adhered to conventional practices. Nursing quality outcomes included assessments of nurses' specialized critical thinking skills, patient nutritional biomarkers (serum albumin, prealbumin), complication rates (aspiration, diarrhea, abdominal distension), and patient satisfaction. Multivariate binary logistic regression analysis identified influencing factors.

• Study Type: Interventional
• Enrollment (Actual): 84
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Jiangsu
    • Taizhou, Jiangsu, China, 225300
      • Taizhou Hospital of Traditional Chinese Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• diagnosis of critical illness by attending physicians or higher-qualified specialists according to established critical care diagnostic standards
• requirement for ICU admission with full access to standardized critical care and medical resources
• preserved partial gastrointestinal function without severe intestinal obstruction or perforation confirmed by certified nutritionists or senior nurses, enabling potential enteral nutrition (EN) or combined EN-parenteral nutrition (PN) support.

Exclusion Criteria:

• patients with severe cognitive impairment or psychiatric instability (e.g., advanced dementia, schizophrenia, status epilepticus) impairing capacity to engage in nutritional assessments or adhere to clinical protocols, which would jeopardize data collection reliability
• terminal-stage conditions (malignancies, renal/hepatic failure) with life expectancy < 7 days or exclusively receiving palliative care, leading to misalignment between their palliative nutritional goals and the study's therapeutic intervention objectives
• congenital metabolic disorders (e.g., phenylketonuria) or short bowel syndrome requiring specialized nutritional protocols, which were incompatible with conventional critical care nutritional protocols and could compromise the generalizability of study findings
• pregnancy/lactation due to unique nutritional demands and potential risks to fetal/infant development inherent in the study design, contravening established ethical standards
• cases involving transfer, voluntary discharge, or withdrawal of consent that compromised data completeness.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Conventional group; The conventional group adhered to conventional nutritional management methods and training	Other: Conventional group; The conventional group adhered to conventional nutritional management methods and training
Other: Evidence-based nursing group; The study group implemented the EBN-based protocol alongside structured training	Other: evidence-based nursing group; The study group implemented the EBN-based protocol alongside structured training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Improvement in Junior Nurses' Specialized Critical Thinking Competency	Change in critical thinking scores measured by the Chinese Critical Thinking Disposition Inventory (CTDI-CV), a 70-item scale evaluating 7 dimensions (truth-seeking, open-mindedness, analyticity, systematicity, self-confidence, inquisitiveness, cognitive maturity) on a 6-point Likert scale. Higher scores indicate superior competency.	Baseline: Before training (Day 0). Post-intervention: 3 months after protocol implementation.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Serum Albumin Levels	Objective nutritional biomarker (g/L) measured via venous blood sampling.	ICU admission (Day 0) and Day 14.
Serum Prealbumin Levels	Short-term nutritional status marker (mg/L) assessed alongside albumin.	Day 0 and Day 14.
Patient Satisfaction	Self-reported satisfaction rated on a 5-point Likert scale (1: extremely dissatisfied, 5: extremely satisfied).	Day 15.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of Aspiration	Binary outcome (yes/no) recorded during EN/PN administration.	Daily monitoring until Day 14
Incidence of Diarrhea	Defined as ≥3 loose stools/day, documented by nurses.	Daily monitoring until Day 14.
Incidence of Abdominal Distension	Assessed via physical examination and patient reporting.	Daily monitoring until Day 14.
Body Weight Changes	Measured in kg (bedside scales for ambulatory patients; estimated for others).	Day 0 and Day 14.
Blood Glucose Fluctuations Description: Time Frame:	Capillary/venous glucose levels (mmol/L) monitored per ICU protocol.	Daily until Day 14

Collaborators and Investigators

• Sponsor: Taizhou Hospital

Study record dates

Study Major Dates

• Study Start (Actual): May 25, 2025
• Primary Completion (Actual): October 5, 2025
• Study Completion (Actual): November 30, 2025

Study Registration Dates

• First Submitted: May 21, 2025
• First Submitted That Met QC Criteria: May 21, 2025
• First Posted (Actual): May 30, 2025

Study Record Updates

• Last Update Posted (Actual): March 19, 2026
• Last Update Submitted That Met QC Criteria: March 18, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Critical Illness
• Other Study ID Numbers: No. 20240625

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No