{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:53:19Z","timestamp":1791183199404,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":276,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"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":["Journal of Nursing Management"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the importance of \u201canalgesia\u2010first\u201d guidelines in intensive care units (ICUs), clinical implementation remains suboptimal due to systemic pressures and subjective dilemmas. However, it remains unclear how ICU nurses comparatively prioritize competing implementation barriers and whether shared patterns of viewpoints exist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to explore shared patterns of ICU nurses\u2019 subjective viewpoints regarding barriers to analgesia and sedation management using Q methodology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Q methodology study was conducted from April 7 to May 7, 2026. The Consolidated Framework for Implementation Research (CFIR) informed development of the 50\u2010statement Q\u2010set and was subsequently used as an interpretive framework after factor extraction. Thirty purposively sampled ICU nurses completed the Q\u2010sort and brief postsort interviews. By\u2010person factor analysis was used to identify shared viewpoint patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three factors were identified, explaining 52.46% of the cumulative variance. Factor 1, \u201cProfessionally Confident and Responsibility\u2010Driven,\u201d emphasized professional responsibility, confidence in analgesia and sedation management, and standardized, guideline\u2010informed practice. Factor 2, \u201cExperience\u2010Driven with Perceived Organizational Support Gaps,\u201d emphasized experiential clinical judgment alongside perceived limitations in previous formal preparation, departmental prioritization, and physician\u2013nurse consensus. Factor 3, \u201cSystemically Isolated and Communication\u2010Restricted,\u201d highlighted communication\u2010related and contextual barriers, including perceived discrepancies between nurse and physician observations, handover discontinuities, environmental constraints, and patient\/family\u2010related influences. As Factor 3 was defined by only two participants, this viewpoint should be considered preliminary. CFIR\u2010informed interpretation indicated that the three viewpoints reflected different configurations of implementation influences at the individual, organizational, interprofessional, and contextual levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The identified heterogeneity in viewpoints suggests that uniform implementation approaches may not fully address the different barriers perceived by ICU nurses. Nursing leaders could consider strategies that are responsive to the implementation influences emphasized across different viewpoints, while the preliminary Factor 3 findings require confirmation in larger and more diverse samples.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/jonm\/3155537","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:43:59Z","timestamp":1791182639000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the Cognitive Phenotypes of Implementation Barriers to Analgesia and Sedation Management Among ICU Nurses: A Q Methodology Study"],"prefix":"10.1155","volume":"2026","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 Shaw Hospital Zhejiang University School of Medicine  Hangzhou China  zju.edu.cn"}],"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 Shaw Hospital Zhejiang University School of Medicine  Hangzhou China  zju.edu.cn"},{"name":"Zhejiang Key Laboratory of Precise Diagnosis and Treatment of Abdominal Infection Sir Run Shaw Hospital School of Medicine Zhejiang University  Hangzhou Zhejiang 310016 China  zju.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8110-6154","authenticated-orcid":false,"given":"Kailai","family":"Gu","sequence":"additional","affiliation":[{"name":"Nursing College Zhejiang Chinese Medical University  Hangzhou China  zcmu.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6269-3533","authenticated-orcid":false,"given":"Yunyi","family":"Zhong","sequence":"additional","affiliation":[{"name":"Intensive Care Unit Sir Run Shaw Hospital Zhejiang University School of Medicine  Hangzhou China  zju.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3454-1427","authenticated-orcid":false,"given":"Yilin","family":"Xu","sequence":"additional","affiliation":[{"name":"Operating Room Sir Run Shaw Hospital Zhejiang University School of Medicine  Hangzhou China  zju.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4093-6431","authenticated-orcid":false,"given":"Kaili","family":"Wang","sequence":"additional","affiliation":[{"name":"Intensive Care Unit Sir Run Shaw Hospital Zhejiang University School of Medicine  Hangzhou China  zju.edu.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnc.2025.05.004"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.5935\/0103-507x.20210069"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.0159"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1710572"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-026-03651-z"},{"key":"e_1_2_13_6_2","first-page":"219","article-title":"Research Progress on Evaluation and Treatment of Sedation and Analgesia in Patients with Severe Neurological Diseases","volume":"18","author":"Maojun L. 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