{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:39:42Z","timestamp":1791221982504,"version":"4.1.0"},"reference-count":69,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Current evidence indicates that suboptimal analgesia and sedation management by ICU healthcare professionalss stems from a combination of knowledge gaps, low adherence to guidelines, high workload and concerns over patient safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To identify and synthesise evidence on ICU clinicians' perceptions regarding barriers and facilitators to analgesia\u2010sedation management, and to derive implementation strategies to support practice improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Mixed\u2010methods systematic review. We systematically searched eight databases (PubMed, EMBASE, Web of Science, CINAHL, Cochrane Library, CNKI, Wan fang, Sino Med and VIP) until September 2025 for studies exploring barriers and facilitators to analgesia\u2010sedation management in the ICU. Two researchers independently screened studies, extracted data and assessed quality using the Mixed Methods Appraisal Tool (MMAT). Thematic synthesis was conducted using the Consolidated Framework for Implementation Research (CFIR) framework, with findings mapped to Expert Recommendations for Implementing Change (ERIC) strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The initial search identified 4821 records. After screening, 36 studies were finally included (comprising 28 quantitative studies, 7 qualitative studies and 1 mixed\u2010methods study). The methodological quality of the included studies was assessed as relatively high. Sixteen barrier factors and 7 facilitator factors were extracted from the included literature and categorised into four core themes: Organisational Management and Resource Support, Education and Training and Knowledge Systems, Beliefs and Perceptions and Willingness to Change and Clinical Practice and Collaborative Execution. Mapping the barrier factors to the CFIR framework revealed that \u2018Inner Setting\u2019 factors significantly influenced all themes except \u2018Organizational Management and Resource Support\u2019. Based on the CFIR mapping results, 10 implementation strategies with expert consensus ratings above 50% were selected from the ERIC strategy library. These strategies were elaborated in detail by integrating the facilitator factors extracted from the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Effective implementation requires barrier\u2010informed strategies. We developed a targeted strategy set through CFIR\u2010ERIC mapping. The findings consolidate evidence on effective analgesia\u2010sedation strategies, providing a reference for clinical practice in the ICU. Future work should develop multi\u2010component interventions and evaluate their effectiveness and sustainability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>This study provides evidence\u2010based strategies for managing analgesia and sedation in the ICU, informing clinical decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>The protocol was registered with PROSPERO in October 2025 (registration number: CRD420251230829).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70391","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:00:22Z","timestamp":1771567222000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Barriers and Facilitators to the Implementation of Analgesia and Sedation Management Strategies Among\n                    <scp>ICU<\/scp>\n                    Healthcare Professionals: A Mixed Methods Systematic Review"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1661-862X","authenticated-orcid":false,"given":"Huiqin","family":"Shi","sequence":"first","affiliation":[{"name":"Intensive Care Unit, Sir Run Run Shaw Hospital Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7536-9978","authenticated-orcid":false,"given":"Jingying","family":"Huang","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Sir Run Run Shaw Hospital Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kailai","family":"Gu","sequence":"additional","affiliation":[{"name":"Nursing College Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5890-4385","authenticated-orcid":false,"given":"Jin","family":"Yang","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Sir Run Run Shaw Hospital Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengbo","family":"Han","sequence":"additional","affiliation":[{"name":"Nursing Department, Sir Run Run Shaw Hospital Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000139"},{"issue":"6","key":"e_1_2_12_3_1","first-page":"497","article-title":"Guidelines for Analgesia and Sedation Treatment in Intensive Care Unit of Chinese Adults","volume":"30","author":"Society Of Critical Care Medicine Chinese Medical Association","year":"2018","journal-title":"Chinese Critical Care Medicine"},{"issue":"4","key":"e_1_2_12_4_1","first-page":"480","article-title":"What Every Intensivist Should Know About Light Sedation for Mechanically Ventilated Patients","volume":"33","author":"Tanaka L. 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